Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX.
Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX.
J Am Coll Surg. 2016 May;222(5):890-905.e11. doi: 10.1016/j.jamcollsurg.2016.01.053. Epub 2016 Feb 6.
Management of perioperative antiplatelet medications in gastrointestinal (GI) surgery is challenging. The risk of intraoperative and postoperative bleeding is associated with perioperative use of antiplatelet medication. However, cessation of these drugs may be unsafe for patients who are required to maintain antiplatelet use due to cardiovascular conditions. The objective of this systematic review was to compare the risk of intraoperative or postoperative bleeding among patients who had GI surgery while on continuous antiplatelet therapy (aspirin, clopidogrel, or dual therapy) with the risk among those not taking continuous antiplatelet medication.
We reviewed articles published between January 2000 and July 2015 from the Medline Ovid and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Studies involving any GI procedures were included if the articles met our inclusion criteria (listed in Methods). The following key words were used for the search: clopidogrel, Plavix, aspirin, antiplatelet, bleeding, hemorrhage, and digestive system surgical procedures. Quality of the studies was assessed, depending on their study design, using the Newcastle-Ottawa score or the Cochrane Collaboration's tool for assessing risk of bias.
Twenty-two studies were eligible for inclusion in the systematic review. Five showed that the risk of intraoperative bleeding or postoperative bleeding among patients who had GI surgery while on continuous antiplatelet therapy was higher compared that for those not on continuous therapy. The remaining 17 studies reported that there was no statistically significant difference in the risks of bleeding between the continuous antiplatelet therapy group and the group without continuous antiplatelet therapy.
The risk of bleeding associated with GI procedures in patients receiving antiplatelet therapy was not significantly higher than in patients with no antiplatelet or interrupted antiplatelet therapy.
胃肠道(GI)手术围手术期抗血小板药物的管理具有挑战性。围手术期使用抗血小板药物与术中及术后出血风险相关。然而,对于因心血管疾病而需要继续抗血小板治疗的患者,停止使用这些药物可能是不安全的。本系统评价的目的是比较接受 GI 手术的患者在持续抗血小板治疗(阿司匹林、氯吡格雷或双联治疗)与未接受持续抗血小板治疗时的术中或术后出血风险。
我们检索了 2000 年 1 月至 2015 年 7 月间在 Medline Ovid 和 Cumulative Index to Nursing and Allied Health Literature(CINAHL)数据库发表的文章。如果文章符合我们的纳入标准(方法中列出),则纳入任何涉及 GI 手术的研究。搜索时使用了以下关键词:氯吡格雷、波立维、阿司匹林、抗血小板、出血、出血、消化系统手术。根据研究设计,使用纽卡斯尔-渥太华量表或 Cochrane 协作偏倚风险评估工具评估研究质量。
有 22 项研究符合系统评价的纳入标准。其中 5 项研究表明,接受 GI 手术的持续抗血小板治疗患者的术中出血或术后出血风险高于未接受持续治疗的患者。其余 17 项研究报告,在出血风险方面,连续抗血小板治疗组与未连续抗血小板治疗组之间无统计学显著差异。
接受抗血小板治疗的患者接受 GI 手术相关出血的风险并不明显高于未接受抗血小板治疗或中断抗血小板治疗的患者。