Saba Elias S, Higgins Michelle K, Heyes Richard, Lott David G
Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A.
Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona, U.S.A.
Laryngoscope. 2020 Dec;130(12):2853-2858. doi: 10.1002/lary.28600. Epub 2020 Mar 5.
OBJECTIVES/HYPOTHESIS: To evaluate whether antithrombotic status impacts the incidence of perioperative or postoperative bleeding in direct microlaryngoscopy (DML).
Retrospective chart review.
Patients undergoing DML in a single surgeon's practice from September 2012 to September 2017 were studied. Included patients underwent DML with or without biopsy, balloon dilation, microsurgery, laser ablation, or vocal fold injection. Patients were stratified based on perioperative antithrombotic status and assessed for rates of peri- and postoperative bleeding and other complications.
Of the 581 patients meeting inclusion criteria, 179 patients (31%) had a history of baseline antithrombotic therapy. Of these patients, 124 had perioperative continuation of their therapy. Medicated patients were older (P < .01), predominately male (P < .01), and increasingly comorbid (P < .01). Perioperative complications unrelated to bleeding occurred in 22 patients (4%), minor perioperative bleeding occurred in four patients (0.7%), and minor postoperative bleeding occurred in 12 of the 479 patients with recorded follow-up (2.5%). There were no postoperative bleeds requiring intervention or readmission, and no recorded thrombotic events during the peri- and postoperative period. There was no difference in perioperative bleeding based on baseline antithrombotic status (P = .81). Patients on baseline antithrombotic therapy were more likely to have a postoperative bleed in comparison to patients without history of antithrombotic use (P < .01). However, there were no significant differences in postoperative bleeding between patients on baseline anticoagulation who continued or ceased their medication perioperatively (P = .45).
Perioperative continuation of antithrombotic medications appears to be safe when performing routine DML.
4 Laryngoscope, 2020.
目的/假设：评估抗血栓状态是否会影响直接喉镜检查（DML）围手术期或术后出血的发生率。
回顾性病历审查。
对2012年9月至2017年9月在单一外科医生处接受DML的患者进行研究。纳入的患者接受了有或无活检、球囊扩张、显微手术、激光消融或声带注射的DML。根据围手术期抗血栓状态对患者进行分层，并评估围手术期和术后出血率及其他并发症。
在符合纳入标准的581例患者中，179例（31%）有基线抗血栓治疗史。在这些患者中，124例在围手术期继续治疗。接受药物治疗的患者年龄较大（P < 0.01），以男性为主（P < 0.01），合并症越来越多（P < 0.01）。22例患者（4%）发生了与出血无关的围手术期并发症，4例患者（0.7%）发生了轻微围手术期出血，在479例有记录随访的患者中，12例（2.5%）发生了轻微术后出血。没有术后出血需要干预或再次入院，围手术期和术后期间也没有记录到血栓形成事件。根据基线抗血栓状态，围手术期出血没有差异（P = 0.81）。与没有抗血栓使用史的患者相比，接受基线抗血栓治疗的患者术后出血的可能性更大（P < 0.01）。然而，围手术期继续或停止用药的基线抗凝患者术后出血没有显著差异（P = 0.45）。
在进行常规DML时，围手术期继续使用抗血栓药物似乎是安全的。
4 喉镜，2020年。
