华法林抗凝患者起搏器术后囊袋出血的观察

目的评价不同措施预防华法林抗凝患者起搏器术后囊袋出血的疗效。方法回顾分析华法林抗凝患者行起搏器植入术的临床资料,根据术中采用不同预防囊袋出血措施分为两组。A组患者术前调整INR至1.5～2.0,围手术期不停用华法林,术中局部应用凝血酶原涂抹囊袋;B组患者术前3天停用华法林,改用低分子肝素替代抗凝治疗,术后恢复使用华法林。比较两种方法预防起搏器术后囊袋出血的效果。结果共840例行起搏器手术患者中,有78例为长期使用华法林抗凝的患者。A组患者42例,术后发生轻度囊袋出血4例,中度囊袋出血1例。B组患者36例,术后发生轻度囊袋出血7例,中度囊袋出血3例,重度囊袋出血1例。结论华法林抗凝患者起搏器植入术后囊袋出血的风险增高,而术前调整INR值并在术中局部应用凝血酶原较围术期低分子肝素替代对预防囊袋出血具有更好的疗效。

Comparative study of pocket hemorrhage after pacemaker implantation in patients with warfarin anticoagulation

Objective To evaluate the effect of different measures on pocket hemorrhage after pacemaker implantation in patients with Warfarin anticoagulation.Methods To review data of patients with pacemaker implantation.According to different measures to prevent pocket hemorrhage,patients were divided into two groups.In Group A patients,INR adjusted to 1.5～2.0 before implantation,warfarin not suspended,prothrombin used in operation.In Group B patients,warfarin suspended three days before implantation,replaced by low molecular weight heparin.The effects of prevent pocket hemorrhage were compared.Results A total of 840 patients undergoing pacemaker implantation,78 cases with long-term use of warfarin anticoagulation.In 42 patients of Group A,mild pocket bleeding in 4 cases,moderate pocket bleeding in 1 case.In 36 patients of group B,mild pocket bleeding in 7 cases,moderate pocket bleeding in 3 cases,severe pocket hemorrhage in 1 case.Conclusions Warfarin anticoagulation in patients with pacemaker implantation increase risk of pocket hemorrage.Compared with low molecular weight heparin,adjusting INR before implantation and using prothrombin in surgery may have better effect on preventing pocket hemorrage.