使用INR/APTT评估手术前出血风险:系统性审查
Hassan Rahhal1, Rebecca Sampat2, Brandon Tse3
1Departamento de Clínica Médica, Instituto Central, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; Faculdade de Medicina, Universidade de São Caetano do Sul, São Paulo, SP, Brazil.
Journal of thrombosis and haemostasis : JTH
|March 6, 2026
概括
在大多数手术中,常规的手术前凝血测试,如前热血素时间 (PT) 和激活的部分血栓形成时间 (APTT),显示出与出血风险的弱联系. 在接受重大腹部手术的肝病患者中,PT可以预测出血.
科学领域:
- 临床病理学 临床病理学
- 手术风险评估手术风险评估
- 基于证据的医学基于证据的医学.
背景情况:
- 血栓激素时间 (PT) 和激活部分血栓塑时间 (APTT) 是标准的手术前测试,用于测定出血风险.
- 关于常规凝血检测的指导方针显示出可变性,趋向于风险分层方法.
- 作为查工具,这些测试的一般实用性受到辩论.
研究的目的:
- 评估术前凝血试验结果与术后出血之间的关联.
- 为了确定PT和APTT在选择性外科手术中的出血事件的预测准确性.
主要方法:
- 随机试验和观察性研究的系统审查.
- 在MEDLINE,EMBASE和EBM评论中进行文献搜索.
- 包括评估PT和APTT预测术后出血的准确性研究.
主要成果:
- 综合了100项研究的质量.
- 在大多数手术类型中,在PT或APTT和出血事件之间发现了弱或不一致的关联.
- 在接受重大腹部手术的晚期肝病患者中,观察到更强的关联.
结论:
- 凝血测试结果 (PT,APTT) 并不总是与小和大多数大选择性手术中的出血风险有关.
- 在接受重大腹部手术的晚期肝病患者中,术前PT可能与出血结果有关.
- 常规的凝血查对大多数手术患者可能没有好处.
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