College of Pharmacy, QU Health, Qatar University, Doha, Qatar.
Department of Pharmacy, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
Clin Appl Thromb Hemost. 2021 Jan-Dec;27:10760296211012093. doi: 10.1177/10760296211012093.
Periprocedural vitamin K antagonist management is a complex process and inherently entails multiple clinical issues. Marked variations have been reported in different aspects of this process. These differences were noted at the clinician and institutional levels owing to the lack of evidence-based data leading to many discrepancies in decision-making. This review aims to address the gap of vitamin K antagonist periprocedural management acknowledged by previously published prescribers' questionnaires. One of the components of this process is "bridging," which aims to provide minimal interruption of the anticoagulation period through the use of heparin products. Recent studies showed that bridging is increasing bleeding risk. Secondly, interruption decision relies on the classification of thromboembolism risk which depends on trials that did not include patients with atrial fibrillation. Thirdly, the interruption duration is different among different International normalization ratio levels, which strengthens the difference in the clinical practice of preoperative vitamin K antagonist management. Lastly, the resumption of a vitamin-K antagonist after surgery has many scenarios according to the procedure and patient risk of bleeding. Vitamin-K antagonist periprocedural management is complicated due to individual practice and the lack of strictly implemented institutional standardized protocols to guide, manage and evaluate the process.
围手术期维生素 K 拮抗剂管理是一个复杂的过程，涉及多个临床问题。在这个过程的不同方面都存在明显的差异。由于缺乏循证数据，导致决策存在许多差异，这些差异在临床医生和医疗机构层面都有所体现。本综述旨在解决之前发表的医生调查问卷中所承认的维生素 K 拮抗剂围手术期管理的差距。该过程的一个组成部分是“桥接”，旨在通过使用肝素产品尽量减少抗凝期间的中断。最近的研究表明，桥接会增加出血风险。其次，中断决策取决于血栓栓塞风险的分类，这取决于未包括房颤患者的试验。第三，不同的国际标准化比值水平之间的中断时间不同，这进一步加强了术前维生素 K 拮抗剂管理的临床实践中的差异。最后，根据手术和患者出血风险，手术后恢复维生素 K 拮抗剂有多种情况。由于个体实践和缺乏严格执行的机构标准化协议来指导、管理和评估该过程，维生素 K 拮抗剂围手术期管理很复杂。
