de Jong Jasper S, Vink Roel, Henny Ch Pieter, Levi Marcel, van den Brink Renee B A, Kamphuisen Pieter Willem
Academisch Medisch Centrum/Universiteit van Amsterdam, Afd. Anesthesiologie, Amsterdam, The Netherlands.
Ned Tijdschr Geneeskd. 2009;153:A83.
If patients being treated with anticoagulants need to undergo an operation then physicians need to consider whether to suspend the use of this medication or to allow its use to be continued. Suspending the use of anticoagulants increases the risk of thrombosis, whereas continued use may cause bleeding complications. No evidence-based scientific research has been carried out regarding best practice for the perioperative use of anticoagulants.Antithrombotic drugs are vitamin K antagonists and platelet aggregation inhibitors. For daily practice, appropriate bridging strategies can be used for perioperative anticoagulant policy for various risk groups, such as patients with venous thromboembolism, atrial fibrillations, mechanical heart valves and coronary heart diseases (including coronary stents) and patients who have experienced a cerebrovascular accident. In the vast majority of cases the treating physician must carefully consider each individual case in order to realise the best policy.
正在接受抗凝治疗的患者若需接受手术，医生则需考虑是暂停使用该药物还是继续使用。停用抗凝剂会增加血栓形成的风险，而继续使用可能会导致出血并发症。目前尚未开展关于围手术期使用抗凝剂最佳做法的循证科学研究。抗血栓药物包括维生素K拮抗剂和血小板聚集抑制剂。在日常实践中，对于不同风险群体，如静脉血栓栓塞、心房颤动、机械心脏瓣膜和冠心病（包括冠状动脉支架）患者以及经历过脑血管意外的患者，围手术期抗凝策略可采用适当的桥接策略。在绝大多数情况下，主治医生必须仔细考虑每个病例，以制定出最佳策略。
