University of New Mexico, Health Sciences Center, College of Pharmacy, Albuquerque, NM.
Tennessee Valley Health Systems (TVHS) Veterans Affairs, Nashville, TN.
Hematology Am Soc Hematol Educ Program. 2021 Dec 10;2021(1):521-528. doi: 10.1182/hematology.2021000287.
Periprocedural management of antithrombotics is a common but challenging clinical scenario that renders patients vulnerable to potential adverse events such as bleeding and thrombosis. Over the past decade, periprocedural antithrombotic approaches have changed considerably with the advent of direct oral anticoagulants (DOACs), as well as a paradigm shift away from bridging in many warfarin patients. Successfully navigating this high-risk period relies on a number of individualized patient assessments conducted within a framework of standardized, systematic approaches. It also requires a thorough understanding of antithrombotic pharmacokinetics, multidisciplinary coordination of care, and comprehensive patient education and empowerment. In this article, we provide clinicians with a practical, stepwise approach to periprocedural management of antithrombotic agents through case-based examples of relevant clinical scenarios.
抗血栓药物的围手术期管理是一种常见但具有挑战性的临床情况，会使患者容易发生潜在的不良事件，如出血和血栓形成。在过去的十年中，随着直接口服抗凝剂（DOACs）的出现，以及许多华法林患者从桥接治疗方式的转变，围手术期抗血栓治疗方法发生了很大变化。成功应对这一高风险时期需要在标准化、系统方法的框架内进行多项个体化患者评估，还需要充分了解抗血栓药代动力学、多学科护理协调以及全面的患者教育和授权。在本文中，我们通过相关临床场景的案例为临床医生提供了一种实用的、逐步的抗血栓药物围手术期管理方法。
