Graw J, Schwenk W, Volk T
Universitätsklinik für Anästhesiologie und Operative Intensivmedizin, Campus Virchow Klinikum und Campus Mitte, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
Chirurg. 2009 Jun;80(6):498-501. doi: 10.1007/s00104-008-1642-3.
According to the present guidelines, patients with coronary stents are to be treated with dual antiplatelet therapy. In case surgery is needed, the risk of a fatal stent thrombosis by withdrawing antithrombotics needs to be balanced in each individual case against the risk of haemorrhagic complications on continued antiplatelet medication. We present a case of fatal stent thrombosis and discuss the current evidence regarding perioperative continuation and interruption of antiplatelet therapy for this patient population. In summary the haemorrhagic risk with acetylsalicylic acid for secondary prevention seems very low, and it should be discontinued only in selected cases. Continued dual anticoagulation concepts are also discussed.
根据目前的指南，冠状动脉支架置入患者需接受双联抗血小板治疗。如需进行手术，则需针对每例患者权衡停用抗血栓药物导致致命性支架血栓形成的风险与继续使用抗血小板药物导致出血并发症的风险。我们报告一例致命性支架血栓形成病例，并讨论目前关于该患者群体围手术期抗血小板治疗持续或中断的证据。总之，阿司匹林用于二级预防的出血风险似乎很低，仅在特定情况下才应停用。文中还讨论了持续双联抗凝的概念。
