Li Wei, Wang Pei, Le Shiguan, Xi Wang, Wang Jing, Yin Liang, Wang Qing, Zhang Yufeng, Wang Zhinong
Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
Department of Cardiothoracic Surgery, General Hospital of Central Theater Command, Wuhan 430012, China.
J Thorac Dis. 2019 Dec;11(12):5266-5273. doi: 10.21037/jtd.2019.11.56.
Whether the benefits of early prophylactic anticoagulation by low molecular weight heparin (LMWH) would outweigh its possible harms in patients after minimally invasive cardiac surgery (MICS) remains contentious. The aims of this study were to define the incidence of venous thromboembolism (VTE) and to assess whether early prophylactic anticoagulation by LMWH postoperatively was indeed effective in reducing VTE without increasing risk of complications after MICS.
This investigation was a single-center, retrospective, propensity score-matched analysis study. A total of 473 patients underwent MICS, of whom 257 received prophylactic anticoagulation with LMWH (LMWH group) in the early postoperative period and 216 were not treated with LMWH (Control group). The main outcome measurements included the incidence of embolism events and major bleeding events, the volume of erythrocyte transfusion, the volume of drainage and the duration of drainage after MICS. In addition, the incidence of poor wound healing, the mechanical ventilation time, ICU stay time and postoperative hospitalization time were also documented.
There were fewer embolic events (P=1.000) and a higher rate of major bleeding events (P=0.008) in the LMWH group than the Control group, and their magnitude and significance were maintained in the propensity matched analysis. In the matched cohorts, there was no significant difference in the total volume of red blood cell transfusion (P=0.552), assisted mechanical ventilation time (P=0.542), and the ICU stay time (P=0.166) between the two groups; while the volume of drainage (P<0.001) and the duration of drainage (P<0.001) in the LMWH group were significantly more than the Control group, and the incidence of poor wound healing (P=0.009) and the postoperative hospitalization time (P<0.001) were significantly increased in the LMWH group.
Early prophylactic anticoagulation with LMWH could not reduce the incidence of embolism events after MICS. Instead, it might increase postoperative major bleeding events and prolong drainage tube indwelling time and the length of hospital stay.
在微创心脏手术（MICS）后患者中，低分子量肝素（LMWH）进行早期预防性抗凝的益处是否会超过其可能的危害仍存在争议。本研究的目的是确定静脉血栓栓塞（VTE）的发生率，并评估术后早期使用LMWH进行预防性抗凝是否确实能有效降低VTE，同时不增加MICS后并发症的风险。
本研究为单中心、回顾性、倾向评分匹配分析研究。共有473例患者接受了MICS，其中257例在术后早期接受了LMWH预防性抗凝治疗（LMWH组），216例未接受LMWH治疗（对照组）。主要结局指标包括栓塞事件和大出血事件的发生率、红细胞输注量、引流量及MICS后的引流持续时间。此外，还记录了伤口愈合不良的发生率、机械通气时间、ICU住院时间和术后住院时间。
LMWH组的栓塞事件少于对照组（P = 1.000），但大出血事件发生率高于对照组（P = 0.008），且在倾向评分匹配分析中其幅度和显著性得以维持。在匹配队列中，两组之间的红细胞输注总量（P = 0.552）、辅助机械通气时间（P = 0.542）和ICU住院时间（P = 0.166）无显著差异；而LMWH组的引流量（P < 0.001）和引流持续时间（P < 0.001）显著多于对照组，且LMWH组伤口愈合不良的发生率（P = 0.009）和术后住院时间（P < 0.001）显著增加。
MICS后早期使用LMWH进行预防性抗凝并不能降低栓塞事件的发生率。相反，它可能会增加术后大出血事件，并延长引流管留置时间和住院时间。
