持续华法林治疗对起搏器植入术后囊袋血肿的影响

目的观察围术期继续应用华法林对起搏器囊袋血肿发生率的影响。方法180例服用华法林的患者接受永久起搏器植入，按照随机表随机分成继续华法林组和肝素桥接组，各90例。继续华法林组患者给予围术期内监测凝血酶原国际化比值，并维持华法林治疗（华法林剂量3．0—6．0mg）；肝素桥接组患者围术期内采用低分子肝素桥接1mg／（kg·12h）]，观察住院期间2周内囊袋的血肿发生率。结果继续华法林组囊袋血肿发生率为6．7％（6／90），肝素桥接组为17．8％（16／90），2组比较差异有统计学意义（P=0．023）。Logistic回归分析显示低分子肝素为发生囊袋血肿的独立危险因素（RR=2．665，95％CI=1．073—8．156，P=0．023）。结论与肝素桥接法比较，围术期继续服用华法林不明显增加起搏器囊袋血肿发生率。

Effect of continuation of warfarin on pocket hematoma in patients with pacemaker implantation

Objective To investigate the effect of continuation of warfarin sodium on the incidence of pocket hematoma compared to heparin bridging. Methods We studied 180 consecutive patients taking warfarin long term underwent pacemaker-implanting procedures. Patients were classified into two groups. The first group continued warfarin therapy while maintain a therapeutic INR within a ＂safe＂ range （ n = 90）. The second adopted heparin bridging strategy （n = 90 ）. Within 2 weeks after pacemaker implanting surgery during hospitalization. Results Twenty-two patients （ 12.2% ） had pocket hematoma. Six patients （ 6.7% ） from continuing warfarin group and 16/90 （ 17.8% ） from heparin bridging group （P = 0.023 ）. Logistic regression analysis showed that low molecular weight heparin was an independent risk factor for the development of pocket hematoma （ RR = 2. 665, 95 % CI：1. 073-8. 156, P = 0. 023 ）. Conclusion Continuation of oral anticoagulation therapy with an INR level of 2-3 does not increase the risk of pocket hematoma occurrence, while precaution is still necessary to avoid supra therapeutic warfarin.