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在手术前抗凝血患者的选择性手术后的血栓和出血结果
Chi Zhang1, Katherine Bews2, Nicholas D Klemen3
1Department of Surgery, Mayo Clinic, Phoenix, AZ; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
Mayo Clinic proceedings
|July 3, 2024
概括
在接受抗凝药治疗的手术患者中,平衡出血和凝血风险是困难的. 大多数出血并发症发生在恢复治疗抗凝药的患者中,这表明早期恢复可能无法预防血栓事件.
科学领域:
- 心血管医学 心血管医学
- 手术结果研究研究.
背景情况:
- 抗凝药的使用正在增加,这在管理术后风险方面带来了挑战.
- 了解接受选择性手术的抗凝血患者并发症的发生率和时间是至关重要的.
研究的目的:
- 调查在接受选择性手术的抗凝血药物治疗患者中发生的血栓和出血并发症的发生率和时间.
- 分析抗凝血恢复和术后并发症之间的关系.
主要方法:
- 利用了美国外科医生学院2011-2021年国家外科质量改善计划数据的机构数据.
- 补充数据与医疗记录审查,以详细了解并发症和抗凝时间.
- 收集了术后出血,急性静脉血栓栓塞 (VTE) 和脑血管事故 (CVA) 的结果.
主要成果:
- 在1442名 (5.8%) 患者中,有84名患者出现并发症,其中68例出血 (4.7%),16例静脉动脉突发症 (1.1%) 和4例心血管梗塞 (0.3%).
- 患有心肌梗塞 (75%),静脉突发症 (62.5%) 和出血 (26.5%) 的患者中,有很大一部分在该事件发生之前恢复了治疗性抗凝药.
- 出血并发症导致8.8%的ICU入院,1.5%的患者死亡.
结论:
- 在接受选择性手术的术前抗凝血患者中,管理出血和血栓风险仍然是一个重大的临床挑战.
- 早期术后恢复抗凝药似乎没有预防血栓事件,因为大多数发生在恢复后.
- 在这个患者队列中,出血并发症是最常见的不良事件.
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