Schellong S M, Haas S, Siebenlist S
Medizinische Klinik 2, Städtisches Krankenhaus Dresden-Friedrichstadt, Friedrichstr. 41, 01067, Dresden, Deutschland.
Unfallchirurg. 2010 Nov;113(11):901-7. doi: 10.1007/s00113-010-1880-y.
Patients under long-term administration of vitamin K antagonists may require temporary interruption of anticoagulation therapy for invasive procedures or trauma surgery. Due to the long half-life of these substances bridging therapy with anticoagulants having a shorter half-life may become necessary. In this situation the risk of bleeding due to the intervention and the risk of thromboembolism due the underlying disease must be assessed. Low molecular weight heparins (LMWHs) are considered to be the medication of choice for bridging anticoagulation, mainly due to practical reasons and as they do not require coagulation monitoring and dose adjustment out of hospital treatment is feasible. Low molecular weight heparins are not authorized for the indication of bridging anticoagulation, however, on the basis of recent studies on large patient cohorts, the evidence of efficacy and safety is significantly better for LMWHs than for unfractionated heparin. New oral anticoagulants will soon become available for stroke prevention in patients with atrial fibrillation and for treatment of venous thromboembolism. Due to the shorter half-lives these compounds will no longer require bridging anticoagulation. However, the trauma surgeon should be familiar with the dosing regimens for different indications in order to adequately decide about the preoperative cessation and the perioperative pause of these anticoagulants.
长期服用维生素K拮抗剂的患者在进行侵入性操作或创伤手术时可能需要暂时中断抗凝治疗。由于这些药物半衰期长，可能有必要采用半衰期较短的抗凝剂进行桥接治疗。在这种情况下，必须评估因干预导致的出血风险以及基础疾病导致的血栓栓塞风险。低分子量肝素（LMWHs）被认为是桥接抗凝的首选药物，主要是出于实际原因，因为它们不需要凝血监测且剂量调整，门诊治疗可行。然而，低分子量肝素未被批准用于桥接抗凝适应症，不过，基于近期对大量患者队列的研究，低分子量肝素的有效性和安全性证据明显优于普通肝素。新型口服抗凝剂很快将可用于预防心房颤动患者的中风以及治疗静脉血栓栓塞。由于这些化合物半衰期较短，将不再需要桥接抗凝。然而，创伤外科医生应熟悉不同适应症的给药方案，以便充分决定这些抗凝剂的术前停药和围手术期暂停。
