Hospital Geral de Fortaleza, Serviço de Anestesiologia, Unidade de Transplante Hepático, Fortaleza, CE, Brazil; Instituto Dr. José Frota, Serviço de Anestesiologia, Membro do Comitê Transfusional, Fortaleza, CE, Brazil.
Braz J Anesthesiol. 2021 Jan-Feb;71(1):65-75. doi: 10.1016/j.bjane.2020.12.007. Epub 2020 Dec 25.
The role of the anesthesiologist in the perioperative management of hemostasis has attracted increasing attention. The fibrinolytic system participates in hemostasis, removing clots after repair of the vascular injury. Over the past two decades, several studies have assessed the efficacy and safety of antifibrinolytic agents in reducing perioperative bleeding and transfusion requirements. Some of the conditions that seem to benefit from antifibrinolytic drugs involve trauma, postpartum hemorrhage, cardiac surgery, spine surgery, knee or hip arthroplasty, urological and gynecological surgery, among others. However, there are currently few publications focusing on the perioperative features of fibrinolytic system, which will be the subject of the present review.
Fibrinolytic physiology, its relationship with the clot structure and its perioperative behavior are described. Pathophysiological mechanisms related to anesthesiology clinical practice and their possible perioperative scenarios are addressed according to a suggested classification. This article aims to provide anesthesiologists with a broader understanding of the normal functioning of fibrinolysis, the mechanisms of possible deviations from normality in the perioperative period, the pathophysiological rationale supporting the current indications of antifibrinolytics, and some recent outcomes obtained with their use.
麻醉师在围手术期止血管理中的作用引起了越来越多的关注。纤溶系统参与止血，在血管损伤修复后清除血栓。在过去的二十年中，已经有几项研究评估了抗纤维蛋白溶解剂在减少围手术期出血和输血需求方面的疗效和安全性。一些似乎受益于抗纤维蛋白溶解药物的情况涉及创伤、产后出血、心脏手术、脊柱手术、膝关节或髋关节置换术、泌尿科和妇科手术等。然而，目前很少有出版物专门关注纤溶系统的围手术期特征，这将是本综述的主题。
描述了纤溶生理学、与血栓结构的关系及其围手术期行为。根据建议的分类，讨论了与麻醉学临床实践相关的病理生理机制及其可能的围手术期情况。本文旨在为麻醉师提供更广泛的理解，包括纤溶的正常功能、围手术期正常功能可能出现的偏离机制、支持抗纤维蛋白溶解剂当前适应证的病理生理依据，以及使用这些药物的一些最新结果。
