Llau Juan V, Lopez-Forte Cristina, Sapena Luisa, Ferrandis Raquel
Department of Anaesthesiology and Critical Care Medicine, University Clinic Hospital, Valencia, Spain.
Eur J Anaesthesiol. 2009 Mar;26(3):181-7. doi: 10.1097/eja.0b013e328324b79f.
It is common that patients who are scheduled for surgery are treated with antiplatelet agents (APAs) due to their wide indications. The management of these APAs in the perioperative period (acetylsalicylic acid alone, a thienopyridine alone or, in most cases, a combination of them) has a dual perspective: the risk of bleeding when the patient is operated under the effect of the APA against the risk of thrombosis if it has been withdrawn. The main challenges for the anaesthesiologist and the surgeon include patients with a coronary stent (mainly, new drug-eluting coronary stents), those undergoing urgent surgery and those undergoing high bleeding risk surgery. We review current protocols and discuss the most recent proposals for the management of APAs in patients undergoing noncardiac surgery. Current recommendations include the maintenance of aspirin if possible throughout the perioperative period, in order to limit the risks of cardiological, vascular or neurological postoperative events, although this makes it necessary to assume a small risk for haemorrhagic complications in some patients. Nevertheless, there are many circumstances that are not clear yet and, in this situation, it is crucial that patients are treated with a multidisciplinary approach (anaesthesiologists, surgeons, cardiologists and haematologists).
由于适应证广泛，计划接受手术的患者常使用抗血小板药物（APAs）进行治疗。围手术期这些抗血小板药物的管理（单独使用乙酰水杨酸、单独使用噻吩并吡啶或在大多数情况下两者联合使用）具有双重考量：患者在抗血小板药物作用下进行手术时的出血风险与停用该药物后的血栓形成风险。麻醉医生和外科医生面临的主要挑战包括患有冠状动脉支架的患者（主要是新型药物洗脱冠状动脉支架）、接受急诊手术的患者以及接受高出血风险手术的患者。我们回顾了当前的方案，并讨论了非心脏手术患者抗血小板药物管理的最新建议。当前的建议包括尽可能在整个围手术期维持使用阿司匹林，以降低心脏、血管或神经方面术后事件的风险，尽管这使得部分患者有必要承担少量出血并发症的风险。然而，仍有许多情况尚不明确，在这种情况下，采用多学科方法（麻醉医生、外科医生、心脏病专家和血液科医生）对患者进行治疗至关重要。
