Perioperative Considerations for Antithrombotic Therapy in Oculofacial Surgery: A Review of Current Evidence and Practice Guidelines.
Perioperative Considerations for Antithrombotic Therapy in Oculofacial Surgery: A Review of Current Evidence and Practice Guidelines.
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DOI：
10.1097/iop.0000000000002058
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发表时间：
2022-05-01
影响因子：
2
通讯作者：
Burnstine, Michael A.
中科院分区：
文献类型：
--
作者：
Kim, Christian;Pfeiffer, Margaret L.;Chang, Jessica R.;Burnstine, Michael A.
最近的调查研究表明，眼面部整形手术中抗血栓药物管理的实践模式存在很大差异。回顾当前的证据和共识指南，以指导抗血栓药物的围手术期管理。 PubMed 数据库关于围手术期抗血栓药物使用的综合文献综述。由于眼整形手术的研究数量有限，围手术期抗血栓治疗主要以回顾性研究、共识建议和其他外科领域的试验为指导。本综述总结了相关医学专业的循证建议，并为外科医生根据患者的个人风险定制抗血栓药物管理提供了背景。手术前决定继续或停止抗血栓药物需要仔细了解风险：术中或术后出血的风险与围手术期血栓栓塞事件的风险。手术后停止和恢复抗血栓药物应始终根据患者的血栓形成风险、手术和术后出血风险以及所涉及的特定药物，并与处方医生一起个体化。一般来说，我们建议接受高出血风险手术（眼眶或泪道手术）的高血栓栓塞风险患者可以停止抗血小板药物、直接口服抗凝剂和华法林，包括桥接华法林与低分子量肝素。低风险患者，无论进行何种手术，都可以停止所有药物。关于抗血栓药物围手术期管理的决定应与患者的内科医生、心脏病专家、血液专家或其他相关医生一起做出，这可能会根据患者风险限制指南的作用，并应根据具体情况使用。需要进一步的研究来提供针对眼面部的循证指南。眼面手术中抗血栓药物的围手术期管理是一个复杂的话题，需要仔细考虑患者和手术的风险因素。
Recent survey studies have demonstrated wide variability in practice patterns regarding the management of antithrombotic medications in oculofacial plastic surgery. Current evidence and consensus guidelines are reviewed to guide perioperative management of antithrombotic medications. Comprehensive literature review of PubMed database on perioperative use of antithrombotic medication. Perioperative antithrombotic management is largely guided by retrospective studies, consensus recommendations, and trials in other surgical fields due to the limited number of studies in oculoplastic surgery. This review summarizes evidence-based recommendations from related medical specialties and provides context for surgeons to tailor antithrombotic medication management based on patient’s individual risk. The decision to continue or cease antithrombotic medications prior to surgery requires a careful understanding of risk: risk of intraoperative or postoperative bleeding versus risk of a perioperative thromboembolic event. Cessation and resumption of antithrombotic medications after surgery should always be individualized based on the patient’s thrombotic risk, surgical and postoperative risk of bleeding, and the particular drugs involved, in conjunction with the prescribing doctors. In general, we recommend that high thromboembolic risk patients undergoing high bleeding risk procedures (orbital or lacrimal surgery) may stop antiplatelet agents, direct oral anticoagulants, and warfarin including bridging warfarin with low-molecular weight heparin. Low-risk patients, regardless of type of procedure performed, may stop all agents. Decision on perioperative management of antithrombotic medications should be made in conjunction with patient’s internist, cardiologist, hematologist, or other involved physicians which may limit the role of guidelines depending on patient risk and should be used on a case-by-case basis. Further studies are needed to provide oculofacial-specific evidence-based guidelines. Perioperative management of antithrombotic medications in oculofacial surgery is a complex topic that requires careful consideration of patient and surgery risk factors.