全球精选文摘 - 血栓－栓塞事件高危患者起博器或植入式心脏除颤器的植入准备：口服抗凝剂还是过渡性静脉肝素治疗？一项前瞻性随机试验

Preparation for pacemaker or implantable cardiac defibrillator implants in patients with high risk of thrombo-embolic events: oral anticoagulation or bridging with intravenous heparin? A prospective randomized trial

Tolosana JM, Berne P, Mont L 2010/4/1 16:25:00

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Eur Heart J, 2009,

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Aims:
Current guidelines recommend stopping oral anticoagulation (OAC) and starting heparin infusion before implanting/replacing a pacemaker/implantable cardioverter-defibrillator (ICD) in patients with high risk for thrombo-embolic events. The aim of this study was to demonstrate that the maintenance of OAC during device implantation/replacement is as safe as bridging to intravenous heparin and shortens in-hospital stay.

Methods and Results:
A cohort of 101 consecutive patients with high risk for embolic events and indication for implant/replacement of a pacemaker/ICD were randomized to two anticoagulant strategies: bridging from OAC to heparin infusion (n=51) vs. maintenance of OAC to reach an INR=2±0.3 at the day of the procedure (n=50). Haemorrhagic and thrombo-embolic complications were evaluated at discharge, 15 and 45 days after the procedure. A total of 4/51 patients (7.8) from heparin group and 4/50 (8.0) from the OAC group developed pocket haematoma following the implant (P=1.00). One haematoma in each group required evacuation (1.9 vs. 2, P=1.00). No other haemorrhagic events or embolic complications developed during the follow-up. Duration of the hospital stay was longer in the heparin group [median of 5 (4–7) vs. 2 (1–4) days; P<0.001].

Conclusion:
Implant of devices maintaining OAC is as safe as bridging to heparin infusion and allows a significant reduction of in-hospital stay.

	Heparin Group (n=51)	OAC Group (n=50)	P-Value
Pocket haematoma	4/51 (7.8%)	4/50 (8%)	1
Drainage haematoma	1/51 (1.9%)	1/50 (2%)	1
Thrombo-embolic events	0/51 (0%)	0/50 (0%)	1
Active endocarditis	1/51 (1.9%)	1/50 (2%)	1
Pneumothorax	1/51 (1.9%)	0/50 (0%)	0.49
Lead displacement	0/51 (0%)	1/50 (2%)	0.5

Table 3: Complications Registered up to 45 Days After Device Implant/Replacement

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高血压	慢性阻塞性肺病
脂肪性肝病	糖尿病
卒中	肺癌
冠心病	子宫内膜异位症
结直肠癌	乳腺癌
心力衰竭	心律失常

病例分析 [栏目介绍]

甲状腺功能亢进合并黄疸

王燕燕王曙

上海交通大学附属瑞金医院内分泌科

患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。

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