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随着需要植入心血管植入性电子器械(CIED)人群的增长和心血管病抗栓治疗的普遍应用,CIED围手术期抗栓治疗策略受到关注。血栓栓塞高危患者,将同时面临CIED围手术期出血并发症和血栓栓塞事件两方面的危险。抗栓治疗策略的选择还影响到患者住院时间的长短和经济费用。目前指南推荐血栓栓塞高危患者手术期间应用肝素替代治疗,但临床目前证据认为肝素桥接治疗和双联抗血小板治疗增加囊袋血肿危险,继续应用抗凝药物及短期停用氯吡格雷继续阿司匹林是较为安全的措施。需要进一步大样本随机化研究来探索及验证理想抗栓策略的有效性和安全性。同时需评估患者的基本临床情况及合并疾病,发展个体化治疗策略。
With the growing population of people requiring implants for implantable cardiovascular devices (ICEDs) and the widespread use of anti-thrombotic agents in cardiovascular disease, the strategy of perioperative antithrombotic therapy for CIED has drawn attention. Patients at high risk of thromboembolism will face both CIED perioperative bleeding complications and thromboembolic events. Antithrombotic treatment options also affect the length of hospitalization and financial costs. Current guidelines recommend that high-risk patients with thromboembolism should be treated with heparin replacement during surgery, but current clinical evidence suggests that heparin bridging and dual antiplatelet therapy may increase the risk of capsular hematoma. Continued use of anticoagulants and short-term discontinuation of clopidogrel for aspirin Safety measures. Further large sample randomization studies are needed to explore and validate the efficacy and safety of the ideal antithrombotic strategy. At the same time to assess the patient’s basic clinical conditions and combined disease, the development of personalized treatment strategies.