Dunning Joel, Versteegh Michel, Fabbri Alessandro, Pavie Alain, Kolh Philippe, Lockowandt Ulf, Nashef Samer A M
Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK.
Eur J Cardiothorac Surg. 2008 Jul;34(1):73-92. doi: 10.1016/j.ejcts.2008.02.024. Epub 2008 Mar 28.
This document presents a professional view of evidence-based recommendations around the issues of antiplatelet and anticoagulation management in cardiac surgery. It was prepared by the Audit and Guidelines Committee of the European Association for Cardio-Thoracic Surgery (EACTS). We review the following topics: evidence for aspirin, clopidogrel and warfarin cessation prior to cardiac surgery; perioperative interventions to reduce bleeding including the use of aprotinin and tranexamic acid; the use of thromboelastography to guide blood product usage; protamine reversal of heparin; the use of factor VIIa to control severe bleeding; anticoagulation after mechanical, tissue valve replacement and mitral valve repair; the use of antiplatelets and clopidogrel after cardiac surgery to improve graft patency and reduce thromboembolic complications and thromboprophylaxis in the postoperative period. This guideline is subject to continuous informal review, and when new evidence becomes available. The formal review date will be at 5 years from publication (September 2013).
本文档围绕心脏手术中抗血小板和抗凝管理问题，呈现了基于证据的专业建议观点。它由欧洲心胸外科学会（EACTS）审计与指南委员会编写。我们将回顾以下主题：心脏手术前停用阿司匹林、氯吡格雷和华法林的证据；减少出血的围手术期干预措施，包括使用抑肽酶和氨甲环酸；使用血栓弹力图指导血液制品的使用；鱼精蛋白逆转肝素；使用凝血因子VIIa控制严重出血；机械瓣膜、组织瓣膜置换及二尖瓣修复后的抗凝；心脏手术后使用抗血小板药物和氯吡格雷以改善移植物通畅率并减少血栓栓塞并发症以及术后血栓预防。本指南会持续进行非正式审查，并在有新证据时进行审查。正式审查日期为自发布（2013年9月）起5年。
