Vela Vásquez R S, Peláez Romero R
Department of Anesthesiology, Reanimation and Pain Therapeutics, Son Llàtzer Hospital, Palma de Mallorca, Islas Baleares, Spain
Department of Anesthesiology, Reanimation and Pain Therapeutics, Son Llàtzer Hospital, Palma de Mallorca, Islas Baleares, Spain.
Br J Anaesth. 2015 Nov;115(5):688-98. doi: 10.1093/bja/aev348.
The safety of aspirin therapy in neuraxial anaesthesia has been historically questioned, and the current recommendations are still heterogeneous. A comprehensive review of clinical evidence and a comparative analysis of European and American guidelines were performed. Low-dose aspirin produces a selective, complete and irreversible cyclooxygenase-1 blockade, and higher doses do not increase the antiplatelet effect. Additional cyclooxygenase-2 blockade by high-dose aspirin might decrease the antithrombotic efficacy by inhibiting endothelial prostacyclin synthesis. Different doses of aspirin have been shown to be safe in a broad population subjected to neuraxial anaesthesia or analgesia. In the few case reports of spinal haematoma involving aspirin therapy, additional complicating factors were present. Considering the available evidence, the majority of national scientific societies agree that the isolated use of aspirin does not increase the risk of spinal haematoma and does not represent a contraindication to neuraxial blocks. The precautions regarding higher doses do not seem to be justified. Although aspirin alone is considered to be safe in neuraxial anaesthesia, the concurrent administration of other antithrombotic drugs significantly increases the risk of spinal haematoma and the recommended safety times for each of these other drugs must be strictly followed. An individualized assessment of the risks and benefits should be performed, before performing a neuraxial technique or catheter removal in a patient receiving aspirin.
阿司匹林用于椎管内麻醉的安全性一直以来都备受质疑，目前的建议仍然存在差异。我们对临床证据进行了全面回顾，并对欧美指南进行了对比分析。低剂量阿司匹林可产生选择性、完全且不可逆的环氧化酶-1阻断作用，而高剂量阿司匹林并不会增强抗血小板效果。高剂量阿司匹林额外的环氧化酶-2阻断作用可能会通过抑制内皮前列环素的合成而降低抗血栓疗效。在接受椎管内麻醉或镇痛的广泛人群中，不同剂量的阿司匹林已被证明是安全的。在少数涉及阿司匹林治疗的脊髓血肿病例报告中，存在其他复杂因素。考虑到现有证据，大多数国家科学协会一致认为，单独使用阿司匹林不会增加脊髓血肿的风险，也不构成椎管内阻滞的禁忌证。关于高剂量阿司匹林的预防措施似乎并无依据。虽然阿司匹林单独使用在椎管内麻醉中被认为是安全的，但同时使用其他抗血栓药物会显著增加脊髓血肿的风险，必须严格遵循针对每种其他药物推荐的安全时间。在对接受阿司匹林治疗的患者进行椎管内操作或拔除导管之前，应进行个体化的风险和获益评估。
