紧急一般外科手术中的抗凝固药:谁出血更多? 东部多中心试验ACES研究ACES研究
Lindsay O'Meara1, Ashling Zhang, Jeffrey N Baum
1From the University of Maryland Medical Center (L.O.), Baltimore, Maryland; Mount Sinai South Nassau (J.N.B.), Oceanside, New York; Penn State Milton S. Hershey Medical Center (A.C.), Hershey, Pennsylvania; UCHealth Memorial Hospital (C.D.), Colorado Springs, Colorado; RWJMS, Rutgers at Newark (J.C.), Newark, New Jersey; Allina Health/Abbott Northwestern Hospital (D.S.C.), Minneapolis, Minnesota; Northwestern University (J.P.), Evanston, Illinois; George Washington University (J.E.), Washington, district of Columbia; Columbia University Irving Medical Center (B.H.), New York, New York; Cooper University (A.G.), Camden, New Jersey; Marshfield Clinic (D.C.C.), Marshfield, Wisconsin; Loma Linda University School of Medicine (R.D.C.), Loma Linda, California; Tufts Medical Center, Tuft University School of Medicine (N.B.), Boston, Massachusetts; Anne Arundel Medical Center (C.F.), Parole, Maryland; Memorial Health University Medical Center (K.M.), Savannah, Georgia; Brooke Army Medical Center (V.S.), Fort Sam Houston, Texas; Sidney Kimmel Medical College: Thomas Jefferson University (P.S.L.), Philadelphia, Pennsylvania; University of California Irvine Medical Center (J.N.), Irvine, California; McLaren Oakland Hospital (J.D.P.), Pontiac, Michigan; Sanford Health (L.H.), Sioux Falls, South Dakota; University of Kentucky Medical Center (J.R.), Lexington, Kentucky; and Methodist Medical Center (M.T.), Dallas, Texas.
直接口服抗凝剂 (DOAC) 和华法林在紧急普通手术患者的使用显示出类似的出血风险. 手术指示和患者疾病严重程度,非抗凝药类型,影响并发症和死亡率.
科学领域:
- 外科手术 手术手术
- 药理学 药理学是指药理学的学科.
- 流行病学 流行病学
背景情况:
- 直接口服抗凝剂 (DOAC) 的使用在紧急普通手术 (EGS) 患者中正在增加.
- 在急性手术环境中,与DOACs相关的出血风险需要进一步调查.
研究的目的:
- 在接受DOAC治疗的患者中比较术前出血并发症与接受紧急/紧急EGS程序 (EGSPs) 的华法林和抗血小板 (AP) 治疗的患者.
主要方法:
- 在21个中心 (2019-2022) 进行前性观察试验.
- 包括18岁以上的患者使用DOAC,华法林或AP在需要紧急/紧急EGSP的24小时内.
- 收集了人口统计,手术前,手术内和手术后的数据;使用ANOVA,基平方和回归模型进行分析.
主要成果:
- 413名患者被纳入:152名 (37%) 接受DOAC,261名 (63%) 接受华法林/AP.
- 在DOAC和华法林/AP组之间,类似的手术内,手术后和手术周边出血并发症和住院死亡率.
- 化疗病史和特定的手术指示 (中肠缺血症,分泌炎) 与出血增加有关;手术内输血/血管压缩剂与死亡率有关.
结论:
- 在EGSP中,外科手术期间出血和死亡率主要受到手术指示和患者疾病严重程度的影响,而不是抗凝剂的类型 (DOAC与华法林/AP).
- 管理策略应优先考虑患者生理学和手术指示,而不是最近使用抗血小板或抗凝剂的担忧.
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