Obstet Gynecol. 2014 Oct;124(4):856-862. doi: 10.1097/01.AOG.0000454931.07554.0a.
Surgery can present a management dilemma for gynecologists whose patients receive chronic antithrombotic therapy because the risk of hemorrhagic complications must be balanced against the risk of thromboembolic complications. Interruption of antithrombotic therapy to reduce perioperative bleeding poses a significant risk of recurrent thromboembolic events. Patients who receive chronic antithrombotic therapy should be seen at least 7 days before a planned procedure, and each woman should be included in decision making regarding risks and benefits specific to her situation. The schedule may need to be altered if the international normalized ratio is at a high level and in patients older than 75 years of age (who may need more time to correct their international normalized ratio). The patient's cardiologist often will have recommendations for the appropriate bridging therapy for a specific valve or stent. A discussion of the risks and benefits of different management schemes for chronic antithrombotic therapy may involve the surgeon, the patient, the anesthesiologist, and the primary care physician.
手术会给接受慢性抗血栓治疗的妇科医生带来管理难题，因为必须权衡出血并发症的风险与血栓栓塞并发症的风险。中断抗血栓治疗以减少围手术期出血会带来显著的血栓栓塞事件复发风险。接受慢性抗血栓治疗的患者应在计划手术前至少 7 天就诊，每位女性都应参与针对其具体情况的风险和获益的决策制定。如果国际标准化比值（INR）较高或患者年龄大于 75 岁（可能需要更多时间来纠正 INR），则可能需要改变方案。患者的心脏病专家通常会针对特定瓣膜或支架提出适当的桥接治疗建议。讨论慢性抗血栓治疗的不同管理方案的风险和获益可能涉及外科医生、患者、麻醉师和初级保健医生。
