在神经外科急诊中对抗抗凝剂和抗血小板药物的作用。
Counteracting the effects of anticoagulants and antiplatelet agents during neurosurgical emergencies.
作者信息
Powner David J, Hartwell Elizabeth A, Hoots W Keith
机构信息
Department of Neurosurgery, Vivian L. Smith Center for Neurologic Research, University of Texas Health Science Center at Houston Houston, Texas 77030, USA.
出版信息
Neurosurgery. 2005 Nov;57(5):823-31; discussion 823-31. doi: 10.1227/01.neu.0000179915.74429.b2.
OBJECTIVE
Emergent neurosurgery may be precipitated or complicated by previous or concomitant administration of anticoagulants, thrombolytic medications, or antiplatelet agents. Recommendations are presented to reverse or counteract the effects of those drugs before or during neurosurgical interventions.
METHODS
Directed literature review.
RESULTS
Evidence-based data specific to neurosurgery are limited.
CONCLUSION
Other clinical experience based on mechanisms of drug action within the coagulation process confirm that single or combined administration of platelet transfusions, fresh frozen plasma, cryoprecipitate, vitamin K, protamine, desmopressin, and recombinant activated factor VII can treat coagulopathies caused by warfarin, heparin, aspirin, adenosine diphosphate-receptor antagonist, glycoprotein IIb/IIIa receptor blocking agents, and thrombolysis. Specific interventions and recommended dosages are reviewed.
目的
急诊神经外科手术可能因先前或同时使用抗凝剂、溶栓药物或抗血小板药物而引发或复杂化。本文提出了在神经外科手术干预之前或期间逆转或抵消这些药物作用的建议。
方法
定向文献综述。
结果
针对神经外科手术的循证数据有限。
结论
基于凝血过程中药物作用机制的其他临床经验证实，单独或联合输注血小板、新鲜冰冻血浆、冷沉淀、维生素K、鱼精蛋白、去氨加压素和重组活化因子VII可治疗由华法林、肝素、阿司匹林、二磷酸腺苷受体拮抗剂、糖蛋白IIb/IIIa受体阻断剂和溶栓引起的凝血病。本文回顾了具体干预措施和推荐剂量。
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