直接口服抗凝剂用于神经轴麻醉和深度外围神经阻塞
Aiman Suleiman1, William J Sauer1, Matthias Eikermann1
1Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
British journal of anaesthesia
|October 10, 2025
概括
在接受神经轴痛解或神经阻塞的患者中,直接口服抗凝剂 (DOAC) 的管理需要平衡出血和凝血风险. PAUSE-2试验表明,一种简化的方法可能是安全的,与保守的ASRA指南不同.
科学领域:
- 麻醉学 麻醉学
- 药理学 药理学是指药理学的学科.
- 血液学 血液学 血液学
背景情况:
- 直接口服抗凝剂 (DOACs) 在神经轴痛解和深度外围神经阻塞期间增加出血风险.
- 在外科手术期间管理DOACs需要平衡血栓栓塞和脊髓外周血液瘤风险.
- 目前的指南,像ASRA的指南一样,建议保守的DOAC中断和潜在水平测试.
研究的目的:
- 将PAUSE-2试验的简化DOAC管理策略的安全性和可行性与ASRA指南进行比较.
- 评估基于药理学的DOAC管理方法,用于接受神经轴麻醉或深度神经阻塞的患者.
- 讨论区域麻醉中不同DOAC管理策略的安全性和价值.
主要方法:
- 审查和讨论PAUSE和PAUSE-2试验的发现.
- 将PAUSE-2协议与美国区域麻醉和疼痛管理学会 (ASRA) 的指导方针进行比较.
- 对特定患者群体的DOAC管理的安全性和价值考虑的分析.
主要成果:
- 早期的PAUSE试验结果表明,较短的DOAC中断时间可能提供相似的安全性.
- PAUSE-2试点试验提供了初步证据,证明了高风险程序中采用简化方法的可行性.
- 脊柱外膜外血瘤是一种罕见但灾难性的并发症,限制了随机对照试验.
结论:
- PAUSE-2方法提供了一种简化,可能更安全的替代方案,用于神经轴麻醉和神经阻塞的保守的DOAC管理.
- 进一步的证据支持基于药理动学的策略,可能减少不必要的DOAC中断.
- 临床医生必须根据患者因素和程序风险权衡不同DOAC管理策略的好处和风险.
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