Möllmann Helge, Nef Holger M, Hamm Christian W, Elsässer Albrecht
Dept. of Cardiology, Kerckhoff Heart Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany.
Clin Res Cardiol. 2009 Jan;98(1):8-15. doi: 10.1007/s00392-008-0718-x. Epub 2008 Oct 13.
The growing incidence of cardiovascular diseases leads to an increase in patients who require treatment with antiplatelet drugs. About 5% of patients who underwent a percutaneous coronary intervention will have to undergo surgery within the first year. In these patients the problem evolves how to handle the antiplatelet therapy in the perioperative period. A continuation of these drugs in order to reduce cardiovascular events is associated with increased perioperative bleeding. Withdrawing antiplatelet agents in order to reduce surgical hemorrhage leads to a significant increase of cardiovascular morbidity and mortality, especially in patients who have been treated with implantation of drug eluting stents. This review balances the specific risks of either approach and offers an algorithm how to manage patients in need for antiplatelet therapy in the setting of (un-)planned surgery.
心血管疾病发病率的不断上升导致需要使用抗血小板药物治疗的患者增多。接受经皮冠状动脉介入治疗的患者中，约5%将在第一年内不得不接受手术。对于这些患者，围手术期如何处理抗血小板治疗成为一个问题。继续使用这些药物以减少心血管事件与围手术期出血增加有关。为减少手术出血而停用抗血小板药物会导致心血管发病率和死亡率显著增加，尤其是在接受药物洗脱支架植入治疗的患者中。本综述权衡了两种方法的具体风险，并提供了一种算法，用于指导在（非）计划手术情况下需要抗血小板治疗的患者的管理。
