Murska Sobota General Hospital, Murska Sobota, Slovenia.
Department of Biopharmaceutics and Pharmacokinetics, Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia.
Eur J Clin Pharmacol. 2019 Jun;75(6):751-767. doi: 10.1007/s00228-019-02636-x. Epub 2019 Feb 5.
This review focuses on the most common drugs administered to surgical patients during the perioperative period that affect the risk of venous thromboembolism (VTE).
Among analgesics, the risk of VTE is increased in patients treated with diclofenac, ibuprofen, and rofecoxib, but not naproxen, while metamizole can confer a protective effect. The relationship between sedatives and VTE has not been sufficiently studied. Tricyclic antidepressants, low-potency serotonin reuptake inhibitors, and antipsychotics have been associated with increased risk of VTE. The use of diuretics in the perioperative period is poorly researched; however, hyponatremia is considered a risk factor. Other factors that may influence the risk of VTE include bridging anticoagulation, allogeneic transfusion, and hemostatic management before surgery. Pharmacotherapy for HIV or cancer may also increase VTE risk.
Increased monitoring for VTE is therefore advisable in surgical patients and those receiving antipsychotics, antidepressants, diuretics, or analgesics.
本篇综述重点关注围手术期应用于外科患者的、影响静脉血栓栓塞症（VTE）风险的最常见药物。
在镇痛药中，接受双氯芬酸、布洛芬和罗非昔布治疗的患者 VTE 风险增加，但萘普生则不然，而甲灭酸可产生保护作用。镇静剂与 VTE 之间的关系尚未得到充分研究。三环类抗抑郁药、低效能 5-羟色胺再摄取抑制剂和抗精神病药与 VTE 风险增加相关。围手术期使用利尿剂的研究较少；然而，低钠血症被认为是一个危险因素。其他可能影响 VTE 风险的因素包括桥接抗凝、同种异体输血以及手术前的止血管理。HIV 或癌症的药物治疗也可能增加 VTE 风险。
因此，建议对接受抗精神病药、抗抑郁药、利尿剂或镇痛药的外科患者和接受这些药物治疗的患者加强 VTE 监测。
