Hidalgo F, Gómez-Luque A, Ferrandis R, Llau J V, de Andrés J, Gomar C, Sierra P, Castillo J, Torres L M
Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Clínica Universidad de Navarra, Pamplona, Navarra, España.
Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, España.
Rev Esp Anestesiol Reanim. 2015 Oct;62(8):450-60. doi: 10.1016/j.redar.2015.01.002. Epub 2015 Feb 18.
There is an almost unanimous consensus on the management of the direct new oral anticoagulants, dabigatran, rivaroxaban, and apixaban in elective surgery. However, this general consensus does not exist in relation with the direct new oral anticoagulants use in emergency surgery, especially in the bleeding patient. For this reason, a literature review was performed using the MEDLINE-PubMed. An analysis was made of the journal articles, reviews, systematic reviews, and practices guidelines published between 2000 and 2014 using the terms "monitoring" and "reversal". From this review, it was shown that the routine tests of blood coagulation, such as the prothrombin time and activated partial thromboplastin time, have a limited efficacy in the perioperative control of blood coagulation in these patients. There is currently no antidote to reverse the effects of these drugs, although the possibility of using concentrated prothrombin complex and recombinant activated factor vii has been suggested for the urgent reversal of the anticoagulant effect.
对于择期手术中直接新型口服抗凝剂达比加群、利伐沙班和阿哌沙班的管理，目前几乎已达成共识。然而，对于新型口服抗凝剂在急诊手术中的使用，尤其是出血患者的使用，尚未达成普遍共识。因此，我们使用MEDLINE - PubMed进行了文献综述。我们对2000年至2014年间发表的期刊文章、综述、系统评价和实践指南进行了分析，检索词为“监测”和“逆转”。通过此次综述发现，常规凝血检查，如凝血酶原时间和活化部分凝血活酶时间，在这些患者围手术期凝血控制中的效果有限。目前尚无逆转这些药物作用的解毒剂，不过有人建议使用浓缩凝血酶原复合物和重组活化因子VII来紧急逆转抗凝作用。
