持续双重抗血小板药物治疗对起搏器植入术后囊袋血肿的影响

目的研究持续双重抗血小板药物（DAP）治疗对起搏器植入术后囊袋血肿的影响。方法2010年6月至2013年1月，北京安贞医院长期服用DAP的起搏装置（EPD）植入的老年患者173例，完全随机分为2组，持续DAP治疗组（87例），围术期持续服用DAP，阿司匹林100mg／d＋氯比格雷75mg／d；低分子肝素桥接组（86例）围术期暂停服用DAP，以依诺肝素1mg／（kg·12h）]桥接治疗。随访观察2组患者EPD植入后围术期内囊袋血肿的发生率。结果持续DAP治疗组囊袋血肿发生率为3．4％（3／87），低分子肝素桥接组的囊袋血肿发生率为16．3％（14／87）。2组比较差异有统计学意义（x^2=11．73，P=0．003）；手术时间、血肿形成时间在2组间差异有统计学意义（P〈0．05）；Logistic回归分析提示，低分子肝素为影响囊袋血肿的独立危险因素（P=0．025）。结论围术期持续DAP治疗不增加EPD植入后囊袋血肿的风险。

Effect of dual anti-platelet therapy on pocket hematoma after electrophysiological device placement

Objective To investigate the incidence of pocket hematoma after electrophysiological device （EPD） placements in patients with dual anti-platelet （DAP） and low molecular weight heparin （LMWH） bridging. Methods One hundred and seventy-three patients with dual antiplatelet drug received the pacemaker implantation and enrolled in this prospective observational analysis. Eighty-seven patients received continue DAP therapy, 86 patients replaced DAP drugs with enoxaparin bridging. The adenosine phosphate-mediated platelet aggregation and the ratio platelet aggregation induced by the arachidonic acid （AA） were tested before operation. The incidence of pocket hematoma was investigated. Results Incidence of pocket hematoma in continuing DAP group was lower than that of discontinue dual AP therapy with （LMWH） bridging therapy group （3.4% vs 16.3 % , x^2 = 11.73, P = 0.003 ）. Patients with LMWH bridging were 5. 102 fold more likely to develop pocket hematoma than DAP individuals. A multiple Logistic regression analysis revealed that LMWH was an independent risk factor for the development of pocket hematoma （P = 0. 025）. Conclusion Continuing dual anti-platelet therapy does not increase the risk of pocket hematoma after antiarrhythmic device placement.