Gulati Vivek, Newman Simon, Porter Kenneth J, Franco Luis C S, Wainwright Tom, Ugoigwe Chika, Middleton Robert
1 Orthopaedic Research Institute, Bournemouth University, Bournemouth UK.
2 Homerton University Hospital, London, UK.
Hip Int. 2018 May;28(3):227-233. doi: 10.1177/1120700018759300.
The increasing use of anticoagulant and antiplatelet therapy for the prevention of thromboembolic disease poses a significant challenge to orthopaedic surgeons treating elderly patients presenting with proximal femoral fractures. Early surgical intervention is known to be beneficial from a clinical perspective and has been encouraged in the UK through the introduction of best practice tariffs providing increased remuneration for prompt treatment. An understanding of the necessary delay to surgery or reversal options for each type of antiplatelet or anticoagulant agent is therefore important. A number of professional bodies have recently produced guidelines that help clinicians manage these patients during the peri-operative period. We review the guidelines relating to antiplatelet and anticoagulant agents during the perioperative period with respect to hip fracture surgery. Antiplatelet agents should not interfere with timing of surgery, but may affect the choice of anaesthetic performed. The action of warfarin should be reversed to expedite surgery. Newer direct oral anticoagulants are more problematic and surgical delay may be necessary, though reversal agents are becoming available.
越来越多地使用抗凝和抗血小板疗法来预防血栓栓塞性疾病，这给治疗股骨近端骨折老年患者的骨科医生带来了重大挑战。从临床角度来看，早期手术干预是有益的，并且通过引入最佳实践收费标准，英国鼓励对及时治疗给予更高报酬。因此，了解每种抗血小板或抗凝剂导致的手术必要延迟或逆转方案很重要。一些专业机构最近制定了指南，以帮助临床医生在围手术期管理这些患者。我们回顾了与髋部骨折手术围手术期抗血小板和抗凝剂相关的指南。抗血小板药物不应干扰手术时间，但可能会影响麻醉方式的选择。应逆转华法林的作用以加快手术。新型直接口服抗凝剂问题更多，可能需要延迟手术，不过逆转剂已开始出现。
