口服华法林的心房颤动患者起搏器植入围手术期不同抗凝方案的比较

Comparison of different anticoagulation methods in perioperative period of pacemaker implantation for atrial fibrillation patients receiving Warfarin therapy

摘要:

探讨不同强度抗凝方案对心房颤动患者心脏起搏器植入术围手术期出血和栓塞事件发生率的影响。方法选取2015 年1 月-2016 年8 月滁州市第一人民医院心内科住院的需要接受起搏器植入治疗且长期服用华法林的房颤患者50 例。根据术前抗凝强度，将患者随机分为正常强度抗凝组25 例和低强度抗凝组25 例。观察并比较两组患者出血和栓塞事件的发生率与围手术期抗凝强度的关系。结果正常抗凝强度组出现2 例（8%）切口渗血，1 例（4%）囊袋血肿，共3 例（12%）出血并发症；低强度抗凝组出现1 例（4%）切口渗血，1 例（4%）囊袋血肿，共2 例（8%）出血并发症。两组间出血并发症比较差异无统计学意义（p >0.05），两组间切口渗血并发症比较差异无统计学意义（p >0.05），两组间囊袋血肿并发症比较差异无统计学意义（p >0.05）。两组患者围手术期内，均无栓塞事件发生。结论对于需要植入起搏器的口服华法林的心房颤动患者，术前正常强度抗凝治疗不会增加起搏器植入围手术期出血事件的发生率，低强度抗凝不增加围手术期血栓栓塞风险。

Abstract:

To investigate the effect of different anticoagulation methods on the incidences of perioperative bleeding and thromboembolic events for patients with atrial fibrillation who were using Warfarin and required pacemaker implantation. Methods Fifty patients with atrial fibrillation were included in this study. They were having long-term oral Warfarin therapy and needed pacemaker implantation therapy in our department from January 2015 to August 2016. The patients were divided into two groups according to the preoperative anticoagulation methods, with 25 assigned to normal intensity anticoagulation group and 25 assigned to receive low intensity anticoagulation. The incidences of bleeding and thromboembolic events were compared between the two groups and their relationships with different anticoagulation methods in perioperative period were analyzed. Results The incidence of incision bleeding was 8% in the normal intensity anticoagulation group and 4% in the low intensity anticoagulation group. The incidence of pocket hematoma was 4% in both groups. There were 3 cases complicated with bleeding in the normal intensity anticoagulation group and 2 in the low intensity anticoagulation group without significant difference (p > 0.05). There was no thromboembolic event in either group during perioperative period.Conclusions For patients with atrial fibrillation who take oral Warfarin in long -term and need pacemaker implantation therapy, preoperative normal anticoagulant therapy does not increase the risk of bleeding complications,preoperative low intensity anticoagulation does not increase the risk of thromboembolic events.