直接服用口服抗凝剂的患者的外科治疗:一篇综述

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Updated: Jun 17, 2025

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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation

Published on: February 28, 2012

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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

概括

在外科手术期间使用直接口服抗凝剂 (DOAC) 对于预防出血和血栓塞栓至关重要. 选择性手术的标准化方案和紧急情况的逆转剂的考虑确保了患者的安全.

科学领域:

心脏病学
药理学
手术管理

背景情况:

直接口服抗凝剂 (DOAC) 是广泛用于心房动和静脉血栓塞栓症.
在手术和非手术过程中有效管理DOACs对于减轻出血和血栓塞栓风险至关重要.

研究的目的:

为接受DOAC治疗的患者制定标准化外科治疗策略.
强调风险分层对程序和适当的DOAC时间的重要性.
讨论抗凝剂在新出现的手术场景中的作用.

主要方法:

将手术分为最小,低至中等和高出血风险类别.
基于程序风险的DOAC停止和恢复的定义协议.
通过标准化策略对结果 (血栓塞和出血率) 的评估.
考虑实验室测试和紧急程序的逆转剂.

主要成果:

选择性手术的标准化治疗导致血栓栓塞率低 (0. 2% - 0. 4%) 和严重出血率低 (1% - 2%).
没有逆转剂的DOAC患者的紧急或紧急手术显示出更高的出血风险 (高达23%) 和血栓栓塞 (高达11%).
在标准化的DOAC管理中,对于可选的程序,不需要使用肝素桥接.

结论:

标准化的外科手术 DOAC 管理协议对选择性手术有效,最大限度地减少并发症和手术延迟.
对于紧急或紧急的程序,评估DOAC水平和考虑逆转剂可能是至关重要的.
这些策略平衡了在DOAC治疗期间接受手术的患者的出血和血栓栓事件的预防.

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