Naito K, Lequint T, Zemirline A, Gouzou S, Facca S, Liverneaux P
Department of Hand Surgery, Strasbourg University Hospitals, 10 Avenue Baumann, 67403 Illkirch, France ; Department of Orthopaedics, Juntendo University, Tokyo, Japan.
Hand (N Y). 2012 Sep;7(3):267-70. doi: 10.1007/s11552-012-9425-1.
It is usual to stop the intake of oral anticoagulants (anti-vitamin K) before surgery. Some authors have shown that during minimal surgery, the relay with low molecular weight heparin (LMWH) may lead to more thromboembolic complications. We present a prospective comparative study while evaluating the results of stopping or continuing anticoagulants in the surgery for carpal tunnel syndrome.
Our series included 21 patients (24 hands) taking anticoagulants on a long-term basis. For the first nine patients (group I), treatment with anticoagulants was stopped before the surgery. For the following 12 patients (group II), treatment with anticoagulants was not interrupted. The evaluation was based on the measurement of pain (VAS), functional score of the Quick D.A.S.H. and grip strength (Jamar®) and search for a haematoma or thromboembolism).
The pain decreased by 3.5 points in both groups. The Quick D.A.S.H. decreased by 19.9 and 27.7 points in groups I and II, respectively. The average grip strength decreased by 2.5 kg in group I and increased by 3.8 kg in group II. A subcutaneous haematoma that got healed by itself was observed in group II. We did not observe any thromboembolic complications.
In conclusion, it seems pointless to stop anticoagulants before surgical treatment of carpal tunnel. The first reason is that continuing anticoagulants does not result in a bleeding risk. The second reason is that this approach removes the theoretical risk of thromboembolic complications during a poorly monitored relay.
手术前通常会停止口服抗凝剂（抗维生素K）的摄入。一些作者表明，在微创手术期间，用低分子量肝素（LMWH）替代可能会导致更多血栓栓塞并发症。我们进行了一项前瞻性对照研究，评估在腕管综合征手术中停止或继续使用抗凝剂的结果。
我们的研究系列包括21例长期服用抗凝剂的患者（24只手）。前9例患者（第一组）在手术前停止抗凝治疗。接下来的12例患者（第二组），抗凝治疗未中断。评估基于疼痛测量（视觉模拟评分法[VAS]）、快速上肢功能障碍量表（Quick D.A.S.H.）的功能评分和握力（Jamar®）测量，以及是否存在血肿或血栓栓塞。
两组患者的疼痛均减轻了3.5分。第一组和第二组的Quick D.A.S.H.评分分别下降了19.9分和27.7分。第一组患者的平均握力下降了2.5千克，第二组患者的平均握力增加了3.8千克。第二组观察到一个自行愈合的皮下血肿。我们未观察到任何血栓栓塞并发症。
总之，在腕管手术治疗前停止抗凝剂似乎没有意义。第一个原因是继续使用抗凝剂不会导致出血风险。第二个原因是这种方法消除了在监测不佳的替代过程中血栓栓塞并发症的理论风险。
