Bell Benjamin R, Spyropoulos Alex C, Douketis James D
University of Toronto, Toronto, Ontario, Canada.
Anticoagulation Services and Clinical Thrombosis Services, Northwell Health Systems at Lenox Hill Hospital, Hofstra Northwell School of Medicine, 130 E, 77th St., New York, NY 10075, USA.
Hematol Oncol Clin North Am. 2016 Oct;30(5):1073-84. doi: 10.1016/j.hoc.2016.05.005.
The periprocedural management of patients on direct oral anticoagulants (DOACs) is a common but potentially challenging clinical problem because there are few prospective studies to guide clinical decisions. Retrospective analyses from randomized trials and observational data suggest that DOACs can be managed in a standardized manner, based on surgical and patient characteristics, that does not result in excess major bleeding or thrombosis. In a case-based manner, this article presents a perioperative DOAC management algorithm and reviews the available and emerging evidence supporting the safety and efficacy of this approach. A free online clinical guidance tool is available from Thrombosis Canada that includes the proposed management algorithm.
直接口服抗凝剂（DOACs）治疗患者的围手术期管理是一个常见但可能具有挑战性的临床问题，因为几乎没有前瞻性研究来指导临床决策。随机试验和观察性数据的回顾性分析表明，基于手术和患者特征，DOACs可以以标准化方式进行管理，不会导致过多的严重出血或血栓形成。本文以病例为基础，提出了一种围手术期DOAC管理算法，并回顾了支持该方法安全性和有效性的现有及新出现的证据。加拿大血栓形成协会提供了一个免费的在线临床指导工具，其中包括所提出的管理算法。
