在接受皮肤髓切除术的患者中继续服用阿司匹林是否安全?
Shree Agrawal-Patel1, Harmenjit Brar1, Marlie Elia2
1Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH.
Urology
|October 1, 2023
概括
通过皮肤瘤切除术 (PCNL) 期间继续用阿司匹林治疗并没有增加术后并发症. 然而,服用额外抗凝药的患者在PCNL期间面临更高的血液并发症风险.
科学领域:
- 腎病學和泌尿病學.
- 心血管医学 心血管医学
- 外科手术的结果
背景情况:
- 美国泌尿器官学会的指导方针对PCNL的抗凝血和抗血小板治疗是禁忌的,因为有出血风险.
- 在术前停止服用阿司匹林可能会增加慢性阿司匹林治疗患者的心血管风险.
- 在接受PCNL的患者中评估术后的结果,无论是否停用阿司匹林,都至关重要.
研究的目的:
- 评估在慢性阿司匹林治疗期间接受皮肤透神经切除术 (PCNL) 的患者的术前结果.
- 为了比较继续服用阿司匹林的患者和在手术前停止服用阿司匹林的患者之间的结果.
- 在阿司匹林治疗的患者中识别PCNL期间并发症的风险因素.
主要方法:
- 在2014年1月至2019年5月期间,对325名接受慢性阿司匹林治疗的患者进行了回顾性评估,这些患者接受了PCNL.
- 将患者分为两组:继续服用阿司匹林和停止服用阿司匹林 (手术前5天).
- 使用后勤回归评估血液学,输血和血栓性并发症.
主要成果:
- 两组之间血红蛋白变化,估计的血液损失,输血,肌素变化,血栓性并发症,再入院或急诊室访问没有显著差异.
- 继续服用阿司匹林的患者停留时间略长 (1.9 vs 1.6 天,P=.03).
- 美国麻醉学会 (ASA) 的较高分数,黑人种族和以前的吸烟与持续使用阿司匹林有关;BMI ≥30与停止使用有关.
- 额外的抗凝药物增加了术后血液病并发症的风险 (OR 2.9,P=.04).
结论:
- 持续使用阿司匹林与接受PCNL的患者手术后并发症的增加无关.
- 与阿司匹林一起需要额外的抗凝药物治疗的患者有更高的血液学并发症风险.
- 这些发现表明,需要重新评估在选定的患者群体中PCNL的阿司匹林中止协议.
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