Lapp H, Neumeister A, Eßer D
3. Medizinische Klinik, HELIOS Klinikum Erfurt, Erfurt, Universität Witten/Herdecke.
Angiologie, HELIOS Klinikum Erfurt, Erfurt.
Laryngorhinootologie. 2015 Jan;94(1):10-7. doi: 10.1055/s-0034-1382000. Epub 2015 Jan 8.
In elective ENT surgery, one frequently sees -patients on oral anticoagulants and platelet inhibitors. While continuation of these therapies increases the risk of bleeding complications, indiscriminate discontinuation can have severe thromboembolic consequences. Furthermore, the number of -anticoagulants and platelet inhibitors in use has increased. The ENT-specialist is regulary confronted with the question of continuation, discontinuation, or bridging of this therapy.
Review of the available literature on bleeding complications associated with ENT interventions performed with and without anticoagulants. Overview of the indications for anticoagulants and the different mechansims of action and properties of the different agents. Development of protocols for risk stratification and for perioperative management.
Patients on oral anticoagulants and platelet inhibitors have significant morbidity and mortality not only due to the underlying diseases, but also due to the perioperative management of these therapies. Perioperative management should be based on well-established treatment guidelines or, in high-risk patients, on multidisciplinary consultation. Even though the recommendations here are evidence-based and cover a multitude of clinical contingencies, they cannot replace clinical decision making, which must consider the specific characteristics and circumstances of the patient, the planned intervention, and the surgical environment.
在择期耳鼻喉科手术中，经常会遇到正在服用口服抗凝剂和血小板抑制剂的患者。虽然继续使用这些药物会增加出血并发症的风险，但不加区分地停药可能会产生严重的血栓栓塞后果。此外，正在使用的抗凝剂和血小板抑制剂的数量也有所增加。耳鼻喉科专家经常面临这种治疗是继续、停药还是桥接治疗的问题。
回顾关于在使用和不使用抗凝剂情况下进行耳鼻喉科干预相关出血并发症的现有文献。概述抗凝剂的适应症以及不同药物的不同作用机制和特性。制定风险分层和围手术期管理方案。
服用口服抗凝剂和血小板抑制剂的患者不仅因其基础疾病，还因其这些治疗的围手术期管理而具有显著的发病率和死亡率。围手术期管理应基于完善的治疗指南，或者在高危患者中基于多学科会诊。尽管这里的建议是基于证据的，涵盖了多种临床情况，但它们不能取代临床决策，临床决策必须考虑患者的具体特征和情况、计划的干预措施以及手术环境。
