Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut, USA.
Curr Opin Anaesthesiol. 2020 Jun;33(3):423-431. doi: 10.1097/ACO.0000000000000873.
As the prevalence of patients on antithrombotics is increasing, anesthesiologists must have a firm understanding of these medications and considerations for their periprocedural management. This review details up-to-date periprocedural management of direct oral anticoagulants (DOACs).
DOACs have favorable pharmacokinetics including quick onset of action and short half-lives. Periprocedural management of DOACs relies heavily on drug half-life as well as procedural risk of bleeding. Other than a few exceptions, the American College of Cardiologists generally recommends complete clearance of oral anticoagulants prior to high-risk bleeding procedures and partial clearance prior to low-risk bleeding procedures. Procedures with little to no clinical risk of bleeding can be performed without any drug interruption or during trough levels. Exceptions to periprocedural DOAC management pertain to electrophysiology procedures.
With the exception of no clinically relevant bleeding risk or certain electrophysiology procedures, DOACs should be discontinued periprocedurally in accordance with bleeding risks and drug's half-life. Bridging is generally not recommended for DOACs.
随着抗血栓药物患者的患病率不断上升，麻醉师必须充分了解这些药物，并考虑其围手术期管理。本篇综述详细介绍了直接口服抗凝剂（DOACs）的最新围手术期管理。
DOACs 的药代动力学特性良好，包括起效迅速和半衰期短。DOACs 的围手术期管理主要依赖于药物半衰期和手术出血风险。除了一些例外情况，美国心脏病学会一般建议在高出血风险手术前完全清除口服抗凝剂，在低出血风险手术前部分清除。对于出血风险较小的手术，可以在不中断药物或在药物最低水平时进行。DOAC 围手术期管理的例外情况适用于电生理程序。
除了无临床相关出血风险或某些电生理程序外，应根据出血风险和药物半衰期来停止 DOACs 的使用。一般不建议对 DOACs 进行桥接治疗。
