DeSancho Maria T, Bardarova Svetoslava, Chapin John
Department of Medicine, Division of Hematology-Medical Oncology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York, USA.
Blood Coagul Fibrinolysis. 2015 Jun;26(4):426-9. doi: 10.1097/MBC.0000000000000275.
Guidelines describing the perioperative management of antithrombotic therapy in patients requiring temporary interruption of vitamin K antagonists (VKAs) were first published in 2008. The objective of this study is to evaluate the perioperative management of anticoagulation of patients on chronic VKA and the incidence of bleeding and thrombotic complications pre and postpublication of the 2008 American College of Chest Physicians (ACCP) guidelines. A retrospective review of 40 patients on chronic VKA requiring temporary discontinuation of VKA due to an invasive or surgical procedure who were referred to a single haematology practice from January 2006 to June 2010. Demographics, indications of VKA, risk factors for thrombosis, type of procedure, bridging regimen and bleeding complications were recorded pre and post-2008 ACCP guidelines. Sixty-one procedures were performed in 40 patients; 60% were women. Indications for anticoagulation were secondary prevention of venous thrombosis (n = 27), arterial thrombosis (n = 8) or both arterial thrombosis and venous thrombosis (n = 4), and primary prevention of arterial thrombosis (n = 1). Twenty patients (50%) had thrombophilia. The most common surgical and invasive procedures were gastrointestinal (33%), gynaecological (15%) and orthopaedic (11%). Bridging regimen with therapeutic-dose subcutaneous low molecular heparin (LMWH) was used in 27 (67.5%) patients, prophylactic-dose LMWH in 12 (30%) and a combination of LMWH therapeutic and prophylactic-dose doses in 11 (27.5%). Three bleeding complications occurred prepublication of the 2008 ACCP practice guidelines, although no bleeding complications occurred after the guidelines were published. Adherence to the 2008 ACCP guidelines for the perioperative management of anticoagulation reduced bleeding complications in patients on chronic VKA treatment.
描述需要暂时中断维生素K拮抗剂（VKA）治疗的患者围手术期抗栓治疗管理的指南于2008年首次发布。本研究的目的是评估长期服用VKA患者的围手术期抗凝管理以及2008年美国胸科医师学会（ACCP）指南发布前后出血和血栓形成并发症的发生率。对2006年1月至2010年6月期间转诊至单一血液科诊所、因侵入性或外科手术需要暂时停用VKA的40例长期服用VKA患者进行回顾性研究。记录2008年ACCP指南发布前后的人口统计学资料、VKA的适应证、血栓形成的危险因素、手术类型、桥接方案和出血并发症。40例患者共进行了61例手术；60%为女性。抗凝的适应证为静脉血栓形成的二级预防（n = 27）、动脉血栓形成（n = 8）或动脉血栓形成和静脉血栓形成（n = 4），以及动脉血栓形成的一级预防（n = 1）。20例患者（50%）有血栓形成倾向。最常见的外科和侵入性手术为胃肠道手术（33%）、妇科手术（15%）和骨科手术（11%）。27例（67.5%）患者采用治疗剂量皮下注射低分子肝素（LMWH）进行桥接治疗，12例（30%）采用预防剂量LMWH，11例（27.5%）采用治疗剂量和预防剂量联合使用LMWH。在2008年ACCP实践指南发布前发生了3例出血并发症，指南发布后未发生出血并发症。遵循2008年ACCP指南进行围手术期抗凝管理可减少长期服用VKA治疗患者的出血并发症。
