Klein Thomas, Bignolas Hugo, Mongardon Nicolas, Abou-Arab Osama, Guinot Pierre Grégoire, Bouglé Adrien, Guerci Philippe
Department of Anesthesiology and Critical Care Medicine, Cardiothoracic and Vascular Anesthesia, University Hospital of Nancy-Brabois, 54511 Vandoeuvre-lès-Nancy, France.
INSERM 1116, DCAC, University of Lorraine, 54500 Vandoeuvre-lès-Nancy, France.
J Clin Med. 2023 Mar 3;12(5):2029. doi: 10.3390/jcm12052029.
The current practices regarding the management of antithrombotic therapy during the early postoperative course of cardiac surgery are not well described.
An online survey with multiple-choice questions was sent to cardiac anesthesiologists and intensivists from France.
The response rate was 27% (n = 149), with 2/3 of the respondents having less than 10 years of experience. A total of 83% of the respondents reported using an institutional protocol for antithrombotic management. A total of 85% (n = 123) of the respondents regularly used low-molecular-weight heparin (LMWH) during the immediate postoperative course. For 23%, 38%, 9%, and 22% of the physicians, LMWH administration was initiated between the 4th and 6th hour, between the 6th and 12th hour, between the 12th and 24th hour, and on postoperative day 1, respectively. The main reasons for not using LMWH (n = 23) were a perceived increased risk of perioperative bleeding (22%), poor reversal compared with unfractionated heparin (74%), local habits and the refusal of surgeons (57%), and its overly complex management (35%). The modalities of LMWH use were widely varied among the physicians. Chest drains were mostly removed within 3 days of surgery with an unchanged dose of antithrombotic therapy. Regarding temporary epicardial pacing wire removal anticoagulation, 54%, 30%, and 17% of the respondents left the dose unchanged, suspended the anticoagulation, or lowered the anticoagulation dose, respectively.
LMWH was inconsistently used after cardiac surgery. Further research is warranted to provide high-quality evidence regarding the benefits and safety of LMWH use early after cardiac surgery.
心脏手术后早期抗血栓治疗管理的当前实践描述并不充分。
向法国的心脏麻醉医师和重症监护医师发送了一份带有多项选择题的在线调查问卷。
回复率为27%（n = 149），三分之二的受访者经验不足10年。共有83%的受访者报告使用机构抗血栓管理方案。共有85%（n = 123）的受访者在术后即刻常规使用低分子量肝素（LMWH）。对于23%、38%、9%和22%的医生，LMWH分别在术后第4至6小时、第6至12小时、第12至24小时以及术后第1天开始使用。不使用LMWH的主要原因（n = 23）是认为围手术期出血风险增加（22%）、与普通肝素相比逆转效果差（74%）、当地习惯以及外科医生拒绝（57%）和管理过于复杂（35%）。医生之间LMWH的使用方式差异很大。胸腔引流管大多在术后3天内拔除，抗血栓治疗剂量不变。关于临时心外膜起搏导线拔除的抗凝，分别有54%、30%和17%的受访者维持剂量不变、暂停抗凝或降低抗凝剂量。
心脏手术后LMWH的使用不一致。有必要进行进一步研究，以提供关于心脏手术后早期使用LMWH的益处和安全性的高质量证据。
