Arias Pou Paloma, González Aquerreta, Martínez Luis José Prieto, Latorre Amaya Delgado, Alonso María Serrano
Department of Hospital Pharmacy, Clínica Universidad de Navarra, Madrid, Spain.
Department of Hospital Pharmacy, Clínica Universidad de Navarra, Pamplona, Spain.
Eur J Hosp Pharm. 2018 Nov;25(6):292-297. doi: 10.1136/ejhpharm-2016-001088. Epub 2017 Feb 23.
Non-vitamin K oral antagonists are being increasingly used. However, broad clinical experience with them is lacking.
To review guidelines and evidence for the use of non-vitamin K oral antagonists in the periprocedural environment.
Despite the clear advantages of vitamin K oral antagonists, their use can entail risks owing to the scarcity of reversal agents. Consensus has been reached about postoperative resumption, which is recommended at 24 hours and 48-72 hours, respectively, after low-risk and high-risk bleeding surgery. Bridging with heparin is recommended in patients with a high risk of thrombosis. Urgent interventions should ideally take place 24 hours after the last dose intake. Major discrepancies exist between the American and the European recommendations for neuraxial procedures. The American proposals recommend suspending the drug for five half-lives, whereas the European approaches suggest suspension of just two half-lives. Suggestions for perioperative discontinuation vary widely. Some authors recommend a longer time of resumption for patients with renal impairment. All agree that there should be an increase in the number of days of interruption in high-risk bleeding procedures versus low-risk bleeding procedures.
A diverse number of approaches have been suggested for perioperative management of novel oral antagonists. American recommendations tend to be more rigorous than those of Europe. A need for more studies that measure health outcomes after the use of these drugs would be indispensable.
非维生素K口服抗凝剂的使用越来越广泛。然而，目前缺乏关于它们的广泛临床经验。
回顾在围手术期使用非维生素K口服抗凝剂的指南和证据。
尽管维生素K口服抗凝剂有明显优势，但由于缺乏有效的拮抗剂，使用时可能存在风险。对于术后恢复用药已达成共识，低风险和高风险出血手术后分别建议在24小时和48 - 72小时恢复用药。对于血栓形成风险高的患者，建议使用肝素进行桥接抗凝。紧急干预理想情况下应在最后一剂药物摄入后24小时进行。美国和欧洲关于神经轴阻滞手术的建议存在重大差异。美国的建议是停药五个半衰期，而欧洲的方法则建议仅停药两个半衰期。围手术期停药的建议差异很大。一些作者建议肾功能损害患者恢复用药的时间应更长。所有人都同意，与低风险出血手术相比，高风险出血手术的中断天数应增加。
对于新型口服抗凝剂的围手术期管理，已经提出了多种方法。美国的建议往往比欧洲的更为严格。迫切需要更多研究来衡量使用这些药物后的健康结局。
