抗凝剂的围手术期管理
Perioperative Management of Anticoagulants.
作者信息
Irizarry-Alvarado Joan M, Seim Lynsey A
机构信息
Division of Consultative and Diagnostic Medicine, Mayo Clinic, Jacksonville, FL 32224, United States.
出版信息
Curr Clin Pharmacol. 2017;12(3):145-151. doi: 10.2174/1574884712666170822092709.
BACKGROUND
The prevalence of anticoagulant use has increased in the United States. Medical providers have the responsibility to explain to patients the management of anticoagulant regimens before an invasive procedure. The pharmacologic characteristics of these medications, specifically their half-lives, are important in timing an interruption of anticoagulant therapy.
OBJECTIVE
The authors review the current guidelines and recommendations for therapeutic interruption of anticoagulants and the involved pharmacologic factors.
METHODS
Guidelines and other literature are summarized with discussion on the pharmacology of each medication. Recommendations on how and when to provide bridging for anticoagulants are discussed. Newer oral anticoagulants also are discussed, along with interruption recommendations.
RESULTS
Literature reveals a conservative approach for using bridging when anticoagulation is interrupted because of higher risks of bleeding. Caution is advised when resuming anticoagulant therapy when neuraxial anesthesia is used.
CONCLUSION
Perioperative healthcare providers need to balance risks and benefits of anticoagulant therapy with its interruption preoperatively.
背景
在美国，抗凝剂的使用普及率有所上升。医疗服务提供者有责任在侵入性手术前向患者解释抗凝治疗方案的管理。这些药物的药理学特性，特别是它们的半衰期，对于确定抗凝治疗的中断时间很重要。
目的
作者回顾了目前关于抗凝剂治疗中断的指南和建议以及相关的药理学因素。
方法
总结指南和其他文献，并讨论每种药物的药理学。讨论了关于如何以及何时为抗凝剂提供桥接治疗的建议。还讨论了新型口服抗凝剂以及中断建议。
结果
文献表明，由于出血风险较高，在中断抗凝治疗时使用桥接治疗的方法较为保守。使用神经轴麻醉恢复抗凝治疗时需谨慎。
结论
围手术期医疗服务提供者需要在抗凝治疗及其术前中断的风险和益处之间取得平衡。
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