麻醉学中的新型口服抗凝药
NOACs in Anesthesiology.
作者信息
Spahn Donat R, Beer Jürg-Hans, Borgeat Alain, Chassot Pierre-Guy, Kern Christian, Mach François, Nedeltchev Krassen, Korte Wolfgang
机构信息
Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland.
Department of Internal Medicine, Cantonal Hospital of Baden, Baden, Switzerland.
出版信息
Transfus Med Hemother. 2019 Aug;46(4):282-293. doi: 10.1159/000491400. Epub 2019 Jan 29.
BACKGROUND
Due to increasing use of new oral anticoagulants (NOACs), clinicians are faced more and more frequently with clinical issues related to these drugs.
OBJECTIVE
The objective of this publication is to make practical suggestions for the perioperative management of NOACs as well as for their handling in overdoses and bleedings.
RECOMMENDATIONS
In elective surgery and creatinine clearance ≥ 50 ml/min, a NOAC should be discontinued 24-36 h before the intervention, and even earlier in case of reduced kidney function. In emergency interventions that cannot be delayed, the management is dependent on the NOAC plasma levels. With levels ≤ 30 ng/ml, surgery can be performed. With levels >30 ng/ml, reversal agents should be considered. In low bleeding risk surgery, NOACs can be re-started 24 h after the intervention, which is prolonged to 48-72 h after surgery with high bleeding risk. In case of NOAC overdose and minor bleedings, temporary discontinuation and supportive care are usually sufficient to control the situation. In severe or life-threatening bleedings, nonspecific and specific reversal agents should be considered.
背景
由于新型口服抗凝药（NOACs）的使用日益增加，临床医生越来越频繁地面临与这些药物相关的临床问题。
目的
本出版物的目的是就NOACs的围手术期管理以及过量用药和出血情况的处理提出实用建议。
建议
在择期手术且肌酐清除率≥50 ml/min时，应在干预前24 - 36小时停用NOACs，肾功能降低时应更早停药。在不能延迟的急诊手术中，管理取决于NOACs的血浆水平。水平≤30 ng/ml时可进行手术。水平>30 ng/ml时应考虑使用逆转剂。在低出血风险手术中，可在干预后24小时重新开始使用NOACs，高出血风险手术后则延长至48 - 72小时。在NOACs过量和轻微出血的情况下，通常暂时停药并给予支持性治疗足以控制局面。在严重或危及生命的出血情况下，应考虑使用非特异性和特异性逆转剂。
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