Postoperative epidural analgesia and oral anticoagulant therapy.
Postoperative epidural analgesia and oral anticoagulant therapy.
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术后硬膜外镇痛和口服抗凝治疗。
DOI：
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发表时间：
1994
影响因子：
5.7
通讯作者：
Joyce L. Schlichting
中科院分区：
文献类型：
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作者：
T. Horlocker;D. Wedel;Joyce L. Schlichting
硬膜外置管与随后的肝素化的相对安全性已经得到了很好的证明。然而，围手术期接受华法林治疗的患者发生神经系统后遗症的风险是多少？本研究回顾性评估全膝关节置换术后接受硬膜外镇痛同时接受低剂量华法林的患者发生脊髓血肿的风险。所有患者均应用小剂量华法林使凝血酶原时间（PT）延长至15.0 ~ 17.3 s（正常为10.9 ~ 12.8 s）。188例患者共置入192根硬膜外导管。所有导尿管均通过18号针头推进。在13例中，在针头和/或导管放置期间注意到血液。除华法林外，36例留置导管患者接受了非甾体抗炎药（NSAIDs）。硬膜外导管留置37.5 +/- 15小时（范围13-96小时）。平均PT直到术后第3天才超过正常范围，直到术后第7天才达到15s。当时华法林累积剂量20.0 +/- 7.6 mg。硬膜外置管拔除时平均PT为13.4±2 s。没有脊髓血肿的迹象。尽管硬膜外置管和随后使用华法林抗凝似乎相对安全，但患者对华法林的反应存在很大差异；因此，应监测凝血状态，避免过度延长PT，并密切观察患者有无脊髓血肿。
The relative safety of epidural catheter placement with subsequent heparinization has been well documented. However, what is the risk of neurologic sequelae in such patients who receive warfarin perioperatively? This study retrospectively evaluates the risk of spinal hematoma in patients receiving postoperative epidural analgesia while receiving low-dose warfarin after total knee replacement. All patients received low-dose warfarin to prolong the prothrombin time (PT) to 15.0-17.3 s (normal 10.9-12.8 s). There were 192 epidural catheters placed in 188 patients. All catheters were advanced through an 18-gauge needle. In 13 instances, blood was noted during needle and/or catheter placement. In addition to warfarin, 36 patients with indwelling catheters received nonsteroidal antiinflammatory drugs (NSAIDs). Epidural catheters were left indwelling 37.5 +/- 15 h (range 13-96 h). The mean PT was not increased beyond the normal range until the third postoperative day and did not reach 15 s until the seventh postoperative day. Cumulative warfarin dose at that time was 20.0 +/- 7.6 mg. Mean PT at the time of epidural catheter removal was 13.4 +/- 2 s. There were no signs of spinal hematoma. Although epidural catheter placement and subsequent anticoagulation with warfarin appears relatively safe, there is a large variability in patient response to warfarin; therefore, coagulation status should be monitored to avoid excessive prolongation of the PT, and the patient should be watched closely for evidence of spinal hematoma.
影响因子：
8.3
作者：
RUFF, RL;DOUGHERTY, JH
通讯作者：
DOUGHERTY, JH