Division of Cardiology, Department of Medicine, Dicle University Heart Centre, Diyarbakir, Turkey.
Department of Cardiology, Mardin Training and Research Hospital, Mardin, Turkey.
Pacing Clin Electrophysiol. 2022 Jun;45(6):733-741. doi: 10.1111/pace.14517. Epub 2022 May 18.
The incidence of postoperative complications following cardiac implantable electronic device (CIED) procedures in patients treated with antithrombotic drugs has not been studied sufficiently. Here we present a comparison of complications after CIED implantations.
Using an observational study design, the study included 1807 patients with a taking antiplatelet drugs (n: 1601), nonvitamin K anticoagulants (NOAC) (n: 136), and warfarin (n: 70) undergoing CIED surgery. Primary endpoint was accepted as cumulative events including composite of clinically significant hematoma (CSH), pericardial effusion or tamponade, pneumothorax, and infection related to device system. Secondary outcomes included each compenent of cumulative events. Multivariable analysis was performed to identify predictors of cumulative events.
The overall cumulative event rate was 3.7% (67 of 1807). Cumulative events occured 3.1% (50 of 1601) in the antiplatelet, 5.1% (7 of 136) NOAC, and 14.3% (10 of 70) warfarin groups (p < 0.001). CSH occurred in 2 of 70 patients (2.9%) in the warfarin group, as compared with 5 of 1601 (0.3%) in the antiplatelet group (p: 0.032). However, no significant differences were found between NOAC and warfarin groups in terms of CSH (0.7% vs. 2.9% respectively, p: 0.267). Warfarin treatment was an independent predictor of cumulative events and increased 2.9-fold the risk of cumulative events. Major surgical complications were rare and did not differ significantly between the study groups.
The incidence and severity of complications may be lower in patients treated with periprocedurally antiplatelet or NOAC therapy when compared with warfarin therapy. Further randomized control studies are required to confirm our findings.
在接受抗血栓药物治疗的患者中，心脏植入式电子设备（CIED）手术后的术后并发症发生率尚未得到充分研究。在此，我们比较了 CIED 植入术后的并发症。
使用观察性研究设计，该研究纳入了 1807 名接受抗血小板药物（n=1601）、非维生素 K 抗凝剂（NOAC）（n=136）和华法林（n=70）治疗的患者进行 CIED 手术。主要终点是接受包括复合临床显著血肿（CSH）、心包积液或填塞、气胸和与设备系统相关的感染在内的累积事件。次要结果包括累积事件的每个组成部分。进行多变量分析以确定累积事件的预测因素。
总体累积事件发生率为 3.7%（1807 例中的 67 例）。抗血小板组、NOAC 组和华法林组的累积事件发生率分别为 3.1%（50/1601）、5.1%（7/136）和 14.3%（10/70）（p<0.001）。华法林组中有 2 例（2.9%）患者发生 CSH，而抗血小板组中有 5 例（0.3%）患者发生 CSH（p：0.032）。然而，NOAC 组与华法林组在 CSH 方面无显著差异（分别为 0.7%和 2.9%，p：0.267）。华法林治疗是累积事件的独立预测因素，使累积事件的风险增加 2.9 倍。主要手术并发症罕见，且各组之间无显著差异。
与华法林治疗相比，围手术期接受抗血小板或 NOAC 治疗的患者的并发症发生率和严重程度可能较低。需要进一步的随机对照研究来证实我们的发现。
