选择性脑外科手术的慢性阿司匹林治疗患者的周术管理:德尔菲研究
Shaun E Gruenbaum1, Alexander Kulikov2, Ilana Logvinov1
1Department of Anesthesiology and Perioperative Medicine, Mayo Clinic-Florida, FL.
Journal of neurosurgical anesthesiology
|April 30, 2025
概括
在进行脑外科手术之前,治疗慢性阿司匹林治疗需要平衡出血和凝血风险. 专家建议在高风险出血手术前5-7天停止服用阿司匹林,但在高血栓风险患者继续服用阿司匹林.
科学领域:
- 神经外科 神经外科
- 麻醉学 麻醉学
- 心脏病学 心脏病学
背景情况:
- 在选择性脑外科手术中,术后用阿司匹林治疗在出血和血栓栓塞的风险之间存在困境.
- 停止服用阿司匹林会减少出血,但可能会增加血栓并发症,特别是在心血管高风险患者中.
研究的目的:
- 制定基于共识的指导方针,用于在接受选择性神经外科手术的患者中管理慢性阿司匹林治疗.
- 为应对平衡出血和血栓风险所带来的临床挑战.
主要方法:
- 一项为期2轮的德尔菲调查,涉及42名国际麻醉师和神经外科医生.
- 评估风险,益处,停止/恢复时间,以及血小板功能测试的实用性.
- 共识定义为在第二轮中达成80%以上的共识.
主要成果:
- 达成共识:持续服用阿司匹林会增加出血风险 (84%),建议在5-7天前停止服用 (87%).
- 强烈同意 (97%) 在高血栓形成风险患者中继续服用低剂量阿司匹林.
- 对于低血栓形成风险患者 (65%同意继续治疗) 仍存在争议;对于例行血小板功能检测没有共识.
结论:
- 基于经验的建议,用于神经外科患者的术后阿司匹林管理.
- 在高血栓风险患者中,强烈支持继续服用阿司匹林;在高出血风险手术前5-7天停止服用阿司匹林.
- 低风险患者需要个性化管理;建议对血小板功能测试进行进一步的研究.
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