应关注术后患者出凝血问题及实验室指标

Emphasis on coagulation problems and laboratory indicators in post-operative patients

2012年2月初美国胸科医师学院(ACCP)第9版《抗栓治疗和血栓预防指南》对骨科大手术后抗凝安全性主要变化有:(1)新加入了新的口服抗凝剂如阿哌沙班、达比加群、利伐沙班以及前8版指南中特别强调没有静脉血栓预防效果的阿司匹林(1B级)。(2)基于对抗凝安全性的考虑,给出了优先选择低分子肝素(LMWH)的建议(2B级)。(3)特别强调了对于接受骨科大手术应用低分子肝素抗凝的患者的用药开始时间要在12 h以外,再加上其他措施,使得在保证VTE预防效果的同时,加大了对抗凝安全性的强调。同时外科医生一定要在术后密切关注术后出血的风险及由抗凝带来的一些其他问题,并且要深入了解和掌握诊断这些出血风险的实验室指标及意义,从而使患者安全度过围手术期。

The mortality rate in venous thromboembolism （VTE） is much higher than that in infections and tumors. Along with promulgating of Antithrombotic Therapy and Prevention of Thrombosis ,9th ed： American College of Chest Physicians （ACCP） Evidence-Based Clinical Practice Guidelines in January 2012, the safety of anticoagulant therapy after major ortho- pedic surgery has been paid attention gradually. There are three main changes： Firstly, it has added some new oral anticoag- ulants, such as Apixaban, Pradaxa, Rivaroxaban and Aspirin （ Being specially emphasised that Aspirin has no effect on DVT prevention in previous 8 editions） （Level 1B）. Secondly, the ACCP recommends that low molecular weight heparin （LM- WH） is a prior choice for safety of anticoagulant （Level 2B）. Finally,the ACCP specially emphasis that the first injection time of LMWH should be later than 12 hours aftermajor orthopedic surgery,and combined with other prevention measures, which could improve the preventive effect of VTE and the safety of anticoagulant therapy at the same time. In addition, sur- geons should pay close attention to postoperative bleeding and other problems caused by anticoagulant therapy. Meanwhile, surgeons should deeply understand and grasp laboratory index of these risks of bleeding and its importance, so as to ensure patients safety in perioperative period.