経口抗凝固剤を直接服用する患者の手術後の管理: レビュー

James D Douketis¹, Alex C Spyropoulos^2,3,4

¹Department of Medicine, St. Joseph's Healthcare Hamilton, and McMaster University, Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada.

JAMA

|August 12, 2024

まとめ

直接投与された経口抗凝固剤 (DOAC) は,出血や血栓塞栓を予防するために極めて重要です. 選択的処置のための標準化されたプロトコルと緊急事態に対する逆転剤の検討は,患者の安全を確保します.

科学分野:

心臓病科
薬理学について
手術管理

背景:

直接経口抗凝固剤 (DOAC) は,心房細動および静脈血栓塞栓症に広く処方されています.
外科的および非外科的処置中のDOACの効果的な管理は,出血および血栓塞栓のリスクを軽減するために不可欠です.

研究の目的:

標準化された手術前治療戦略を DOAC 患者のために概説する.
リスクの階層化と適切な DOAC タイミングの重要性を強調する.
新興手術シナリオにおける抗凝固剤の逆転作用について議論する.

主な方法:

処置を最小,中等,高出血リスクのカテゴリーに分類する.
処置リスクに基づいてDOACの中止と再開のための定義されたプロトコル.
標準化戦略によるアウトカム (血栓塞栓と出血率) の評価
緊急処置のための実験室検査と逆転剤の検討

主要な成果:

選択的処置の標準化管理は,低血栓塞栓症 (0. 2% - 0. 4%) と重度の出血 (1% - 2%) を引き起こした.
逆転剤を使用していない患者における緊急または緊急処置では,出血 (最大23%) と血栓塞栓症 (最大11%) のリスクが高かった.
標準化されたDOAC管理では,選択的な手順ではヘパリンブリッジは必要ありません.

結論:

標準化された外科手術後のDOAC管理プロトコルは,選択的処置に有効であり,合併症や処置の遅延を最小限に抑えることができます.
緊急または緊急の処置では,DOACレベルを評価し,逆転剤を検討することが重要です.
これらの戦略は,DOAC治療中に手術を受ける患者の出血および血栓塞栓の予防をバランスとします.

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