抗栓治疗患者眼科围手术期的处理

Perioperative management of ophthalmic patients on antithrombotic therapy

大多数需要眼科手术的老年患者同时定期应用抗血小板和抗凝药物。抗栓治疗可引起球后出血、脉络膜上腔出血等出血性并发症,甚至导致失明,然而中断患者的抗血栓药物可能诱发血栓形成,造成严重不良后果。但目前并没有针对应用抗血小板和抗凝药物眼科患者围手术期管理的指南。患者回顾了传统和新型抗栓药物在白内障、玻璃体视网膜、青光眼及眼眶手术前后的使用,对眼科手术围手术期各类抗血小板和抗凝药物的继续使用、中断和恢复用药提出建议,以减少出现出血性或血栓性并发症的风险。

The large majority of elderly patients undergoing ophthalmic surgery take antiplatelet and anticoagulant drugs on a regular basis. Antithrom botic treatm ents predisposes to bleeding com plications that may lead to retrobulbar haem orrhage, suprachoroidal haem orrhage and ultimately, to loss of vision. However,discontinuation of antithrom botic medication in such patients may lead to throm boembolic events ith serious consequences. There are no guidelines on perioperative m anagement of ophthalmic patients who are on antiplatelet and anticoagulant drugs. We reviewed traditional and new er agents in the context of cataract,vitreoretinal, glaucom a and oculoplastic surgery.Recomm endations are given for continuation,cessation and recommencement of these agents in order to minimise the risk of bleeding and throm botic complications.