Fujikawa Takahisa
Surgery, Kokura Memorial Hospital, Kitakyushu, JPN.
Cureus. 2022 Mar 24;14(3):e23471. doi: 10.7759/cureus.23471. eCollection 2022 Mar.
Antiplatelet medicines and anticoagulants are two types of antithrombotic pharmaceuticals, with anticoagulants including warfarin and direct oral anticoagulants (DOACs). During the perioperative phase, patients receiving antithrombotic therapy must balance two risks: bleeding and thromboembolism. To date, there are no defined recommendations for antithrombotic drug management in gastroenterological (GE) surgery, and the management strategy varies greatly between hospitals. The perioperative treatment of antithrombotic medications should be centralized according to the mechanism of each drug, and a suitable management strategy should be established. The proposed perioperative management for patients undergoing antithrombotic therapy is as follows: (1) in the case of antiplatelet medication, aspirin monotherapy is continued; (2) for patients on warfarin, it is substituted by DOAC bridging (preferred) or heparin bridging; and (3) in the case of DOACs, the short-term withdrawal of DOACs (typically 1-2 days) without heparin bridging is indicated. In the current review, the current state and future prospects of perioperative antithrombotic medication treatment during gastroenterological surgery are discussed.
抗血小板药物和抗凝剂是两种抗血栓形成药物，抗凝剂包括华法林和直接口服抗凝剂（DOACs）。在围手术期，接受抗血栓治疗的患者必须平衡两种风险：出血和血栓栓塞。迄今为止，对于胃肠外科（GE）手术中的抗血栓药物管理尚无明确的建议，而且各医院之间的管理策略差异很大。抗血栓药物的围手术期治疗应根据每种药物的作用机制进行集中管理，并应制定合适的管理策略。对于接受抗血栓治疗的患者，建议的围手术期管理如下：（1）对于抗血小板药物治疗的患者，继续使用阿司匹林单药治疗；（2）对于服用华法林的患者，用DOAC桥接（首选）或肝素桥接替代；（3）对于使用DOACs的患者，建议短期停用DOACs（通常为1 - 2天）且不进行肝素桥接。在本综述中，讨论了胃肠外科手术期间围手术期抗血栓药物治疗的现状和未来前景。
