Stahl F, Rühl H, Goldmann G, Strieth S, Send T
Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Klinik für experimentelle Hämatologie und Transfusionsmedizin, Universitätsklinikum Bonn (UKB), Venusberg-Campus 1, 53127, Bonn, Deutschland.
HNO. 2022 Sep;70(9):705-714. doi: 10.1007/s00106-022-01201-w. Epub 2022 Aug 17.
Considering the increasing number of patients suffering from drug-induced coagulation disorders caused by antiplatelet or anticoagulant therapy, the right balance between minimizing the risk of bleeding and the risk of a venous thrombosis or embolism during otorhinolaryngologic (ORL) surgery is becoming increasingly important. According to a recent study, the highest risk of intraoperative bleeding in ORL surgery is associated with transoral tumor surgery, tonsillectomy, thyroidectomy, and glomus tumor surgery. The risk of venous thrombosis or embolism during ORL surgery is estimated to be 1%, and increases to 6% among tumor patients. Currently, there is no general recommendation for perioperative hemostatic management because of the limited available data. In the majority of patients who continue antiplatelet therapy with acetylsalicylic acid (ASS) to prevent thromboembolic events, the perioperative bleeding risk is considered to be acceptable. For patients with dual antiplatelet therapy, surgical procedures should be only performed after adaption of the medication.
鉴于接受抗血小板或抗凝治疗而导致药物性凝血障碍的患者数量不断增加，在耳鼻喉科（ORL）手术期间，在将出血风险和静脉血栓形成或栓塞风险降至最低之间找到恰当平衡变得愈发重要。根据最近一项研究，耳鼻喉科手术中术中出血风险最高的情况与经口肿瘤手术、扁桃体切除术、甲状腺切除术和球瘤手术有关。耳鼻喉科手术期间静脉血栓形成或栓塞的风险估计为1%，在肿瘤患者中则升至6%。由于可用数据有限，目前尚无关于围手术期止血管理的通用建议。在大多数继续使用乙酰水杨酸（ASS）进行抗血小板治疗以预防血栓栓塞事件的患者中，围手术期出血风险被认为是可接受的。对于接受双重抗血小板治疗的患者，应仅在调整药物治疗后进行外科手术。
