抗凝抗血小板药物对起搏器植入术后囊袋出血的影响

目的研究围手术期应用抗凝及抗血小板药物对起搏器植入术后囊袋出血的影响。方法回顾3年来在本院行起搏器植入或更换的患者资料,对其中血栓高危患者在不停用抗凝或抗血小板药物的情况下,手术完成情况进行分析,了解围手术期抗凝和抗血小板药物的使用方法及术后囊袋出血情况。结果所有26例均顺利完成手术,15例术后起搏器囊袋正常,4例囊袋部位出现大于5cm×5cm瘀斑,7例发生囊袋血肿,其中严重出血5例,发生率为19.23%。严重出血见于围手术期用双重抗血小板药物或抗凝药物治疗。经适当处理,囊袋出血消失。随访3.0±2.6个月,无迟发囊袋出血发生。结论①围手术期使用单一抗血小板药物或短期应用低分子肝素替代双重抗血小板药物相对安全;②围手术使用双重抗血小板药物或单纯抗凝治疗发生囊袋出血的风险高,且抗凝治疗多为严重出血。

The effect of anticoagulant or antiplatelet drug on pocket hemorrhage after pacemaker implantation

Objective To investigate the effect of anticoagulant or antiplatelet drug on pocket hemorrhage after pacemaker implantation during perioperation. Methods To review patients＇ data who received pacemaker implantation or replacement in our hospital since 2006, and analyze the patients＇data who didn＇t discontinue anticoagulant or antiplatelet therapy during perioperation because of high-risk factors for thromboembolic event. The protocal of anticoagulant or antiplatelet using in perioperation and postoperation complication of pocket bleeding were studied. Results Twenty-six patients were successfully implanted pacemarker, 15 patients of whom without pocket bleeding, 4 patients with 〉 5 cm × 5 cm ecchymosis in pocket area, and 7 patients with pocket hematoma. Severe bleeding happened in 5 patients who took dual antiplatelet or anticoagulant treatment. Pocket bleedings were gradually absorbed by properly management. Following-up 3.0 ± 2.6 months, no late pocket hematoma happened. Conclusion （1） Taking single-antiplatelet or using LMWH instead of dual-antiplatelet in short-term during the perioperation is relatively safe. （2） Taking dual-antiplatelet or only using anticoagulant only during the perioperation has a high incidence of pocket bleeding, and using anticoagulant only usually causes severe bleeding.