在心血管植入式电子设备手术期间进行抗凝剂治疗
Aurelija Daubaraitė1, Germanas Marinskis2, Gediminas Račkauskas2
1Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
概括
在心脏器械手术期间继续抗凝治疗比通过氨酸桥梁的中断更安全. 两种非维生素K口服抗凝剂的延续和中断策略似乎对接受心律装置植入的患者都是安全的.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
- 医疗器械 医疗器械
背景情况:
- 抗凝治疗对于预防血栓栓塞事件至关重要,但在手术过程中存在出血风险.
- 在心血管植入式电子设备 (CIED) 植入过程中经过手术期间管理抗凝药,需要仔细考虑安全性和有效性.
研究的目的:
- 系统地评估CIED手术中术前抗凝策略的安全性和有效性.
- 为了比较心律装置植入期间抗凝治疗的不同管理方法.
主要方法:
- 一个全面的随机对照试验和观察性研究的综述,发表到2023年4月.
- 选择了比较抗凝血管理策略及其相关出血或血栓栓塞并发症的研究.
主要成果:
- 在中断和继续服用非维生素K口服抗凝剂 (NOACs) 之间,在出血或血栓栓塞并发症方面没有显著差异.
- 持续使用华法林与设备口袋血瘤的风险明显降低,相比于与氨酸桥接的中断华法林.
- 达比加特兰显示,与与肝素桥接的华法林相比,口袋血瘤的风险较低.
结论:
- 在治疗水平上继续使用维生素K对抗剂 (VKA) 较于与氨酸桥接的中断更安全.
- 在心脏器械手术期间,NOAC的延续和中断策略都是安全和适当的.
- 与CIEDs的周围手术抗凝剂相关的出血和血栓栓塞并发症通常很少见.
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