长期口服华法林治疗的心房颤动患者起搏器植入围手术期不同抗凝方式的比较

摘要

Objective To investigate the appropriate anticoagulation method during perioperative period of pacemaker implan-tation in patients with atrial fibrillation receiving long-term warfarin therapy.Methods One hundred and ten patients with atrial fibril-lation,who needed to implant pacemakers and received long-term warfarin therapy,admitted to our department from July 2013 to July 2017 were enrolled in the study.Their data were prospectively analyzed.The patients were divided into 3 groups according to the periop-erative anticoagulation methods:stopped group (n=33),bridged group (n=37) and continued group (n=40).The association of dif-ferent perioperative anticoagulation methods with bleeding and thromboembolic events was analyzed.Results The incidence of bleeding complications,mainly manifested as pocket hematoma,in the bridging group were higher than other two groups(P < 0.05).No throm-boembolic events occurred in the three groups.Conclusion For pacemaker implantation patients with atrial fibrillation who receive long-term warfarin therapy,the preoperative normal anticoagulant therapy does not increase the risk of bleeding complications.However, heparin bridging anticoagulation significantly increases bleeding complications.%目的 探讨长期使用华法林治疗的心房颤动患者起搏器植入围手术期恰当的抗凝方式.方法 回顾性分析2013年7月至2017年7月在我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110例,根据围手术期抗凝方式的不同分为停用组33例、桥接组37例和继续组40例,分析不同抗凝方式与出血和栓塞事件发生率的关系.结果 桥接组出血并发症发生率高于其他两组(P<0.05),主要表现为囊袋血肿发生率明显升高(P <0.05).三组均未出现栓塞事件.结论 对于需要植入起搏器的口服华法林的心房颤动患者,术前继续华法林抗凝治疗不会增加起搏器植入围术期出血事件的发生率,而肝素桥接抗凝则明显增加出血并发症.