Peri-operative management of anticoagulation and antiplatelet therapy
Peri-operative management of anticoagulation and antiplatelet therapy
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DOI：
10.1111/bjh.14344
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发表时间：
2016-11-01
影响因子：
6.5
通讯作者：
Watson, Henry
中科院分区：
文献类型：
--
作者：
Keeling, David;Tait, R. Campbell;Watson, Henry
关于华法林的BSH指南（Keeling，et al 2011）解决了围手术期管理问题，并在本文中进行了更新，以纳入直接口服抗凝剂（DOAC）和抗血小板药物患者的围手术期管理问题，这些药物正在成为频繁的临床质询。本指南将考虑在择期手术和侵入性手术前是否以及何时应停用抗凝剂和抗血小板药物，何时可以重新开始使用药物以及如何管理需要紧急手术的使用这些药物的患者。如果抗凝剂或抗血小板作用持续存在，则可通过术前使用肠外氨甲环酸改善止血，已证明氨甲环酸可减少心脏和创伤手术中的失血量和输血需求，而不会增加血栓形成并发症（McIlroy等人，2009，Shakur，等人2010）对于具有缓慢抵消和起效的药物，在被认为处于高剂量的患者中，可以考虑使用全治疗剂量的替代药物进行桥接治疗。血栓形成的风险;这主要涉及当暂时停用华法林时，应给予治疗剂量的低分子量肝素（LMWH）还是普通肝素（UFH）。低剂量LMWH的血栓预防不被视为“桥接”。
A BSH guideline on warfarin (Keeling, et al 2011) addressed the issue of perioperative management and is updated in this article to include the issue of perioperative management of patients on direct oral anticoagulants (DOACs) and antiplatelet agents which are becoming frequent clinical queries. This guideline will consider whether and when anticoagulants and antiplatelet agents should be stopped before elective surgery and invasive procedures, when agents can be restarted and how to manage patients on these drugs who require emergency surgery. If an anticoagulant or antiplatelet effect persists haemostasis may be improved by the use of pre-operative parenteral tranexamic acid which has been shown to reduce blood loss and transfusion requirements in both cardiac and trauma surgery, without increasing thrombotic complications (McIlroy, et al 2009, Shakur, et al 2010)For agents with a slow offset and onset of action bridging therapy with an alternative drug at a full treatment dose can be considered in patients deemed to be at high risk of thrombosis; this mainly concerns whether treatment dose low molecular weight heparin (LMWH) or unfractionated heparin (UFH) should be given when warfarin is temporarily discontinued. Thromboprophylaxis with low dose LMWH is not regarded as “bridging”.