在选择性手术时的直接口服抗凝剂水平
Eleonora Camilleri1, Payam Shahbabai2, Mandana Rad3
1Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
JAMA network open
|February 4, 2026
概括
在手术前停止直接口服抗凝剂 (DOAC) 的标准化方案可能会使一些患者的DOAC水平升高,特别是那些服用阿皮克萨班的患者,尽管这与外科手术流血增加无关.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
- 手术医学 手术医学
背景情况:
- 直接口服抗凝剂 (DOACs) 需要根据标准化的协议在选择性手术前进行中断.
- 有可能出现高的手术前DOAC水平,引发人们对增加出血风险的担忧.
研究的目的:
- 为了确定在选择性手术前DOAC水平升高的患病率.
- 为了确定与DOAC水平相关的因素.
- 评估DOAC水平与外科手术失血之间的关联.
主要方法:
- 一项队列研究 (DALI) 包括257名接受阿皮克萨班,达比加特兰或里瓦罗克萨班治疗的患者,这些患者正在接受选择性手术.
- 术前的血液样本使用液态染色体质谱分析了DOAC水平.
- 多变量回归确定了与DOAC水平相关的因素;血液损失也被评估.
主要成果:
- 7.6%的患者在手术前的DOAC水平≥30 ng/mL;对于阿皮克萨班 (13.1%),这一数字更高.
- 高水平与使用阿皮克萨班,降低功能和更短的中断时间有关.
- 在手术前的DOAC水平和手术后的流血之间没有发现显著的关联.
结论:
- 大多数患者坚持DOAC中断协议,但发生升高的水平,特别是在阿皮克萨班.
- 手术前的DOAC水平与手术期间的血液损失增加无关.
- 目前的方案似乎对外科手术出血是安全的,尽管偶尔会有升高的水平.
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