Ohkuma Mari, Fukui Mariko, Hattori Aritoshi, Matsunaga Takeshi, Tomita Hisashi, Takamochi Kazuya, Suzuki Kenji
Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3 Hongo 3-chome, Bunkyo-ku, Tokyo, 113-8431, Japan.
Surg Today. 2025 Jan;55(1):116-122. doi: 10.1007/s00595-024-02942-7. Epub 2024 Oct 10.
The outcomes of direct oral anticoagulant use after noncardiac thoracic surgery have not been elucidated. We compared the safety and efficacy of the postoperative use of direct oral anticoagulants versus warfarin.
This retrospective cohort study included patients taking anticoagulants after noncardiac thoracic surgery between 2008 and 2021. Patients were divided into 2 groups based on drug type: Group D (direct oral anticoagulants) and Group W (warfarin). The occurrence of bleeding and thromboembolic events was also assessed.
Anticoagulants were administered to 434 postoperative patients. One (0.4%) of the 247 patients in Group D and 3 (1.6%) of the 187 patients in Group W experienced thromboembolic events. Four patients (1.6%) in Group D and 4 (2.1%) patients in Group W experienced bleeding events. All bleeding events in Group D occurred within 1 week of oral administration, whereas only 1 case of bleeding occurred after resumption in Group W.
The outcomes of patients treated with direct oral anticoagulants did not differ from those of patients treated with warfarin. However, major bleeding can occur after the postoperative resumption of direct oral anticoagulant use. Attention should be paid to resuming oral anticoagulants within a few days of non-cardiac thoracic surgery.
非心脏胸外科手术后使用直接口服抗凝剂的结果尚未阐明。我们比较了术后使用直接口服抗凝剂与华法林的安全性和有效性。
这项回顾性队列研究纳入了2008年至2021年间非心脏胸外科手术后服用抗凝剂的患者。根据药物类型将患者分为两组：D组（直接口服抗凝剂）和W组（华法林）。还评估了出血和血栓栓塞事件的发生情况。
434例术后患者接受了抗凝治疗。D组247例患者中有1例（0.4%）发生血栓栓塞事件，W组187例患者中有3例（1.6%）发生血栓栓塞事件。D组有4例患者（1.6%）发生出血事件，W组有4例患者（2.1%）发生出血事件。D组所有出血事件均发生在口服给药后1周内，而W组仅1例出血事件发生在恢复用药后。
接受直接口服抗凝剂治疗的患者的结果与接受华法林治疗的患者的结果没有差异。然而，非心脏胸外科手术后恢复使用直接口服抗凝剂后可能发生大出血。在非心脏胸外科手术后几天内恢复口服抗凝剂时应予以注意。
