侵入性操作前的出血风险评估与抗凝治疗的管理

Management of Anticoagulation and Assessment of the Risk of Bleeding before Invasive Procedures

越来越多的患者由于冠状动脉支架植入、心房颤动、机械心脏瓣膜置换以及深静脉血栓形成等原因,需要接受长期的抗凝治疗。这些长期接受抗凝治疗的患者中每年有10%的人由于接受外科手术或其他侵入性操作而需要暂时中止抗凝治疗。这些患者同时面临两个问题,即出血的风险和血栓栓塞的风险。面对择期手术和急诊手术等不同的侵入性操作,具体的临床选择又会不同。临床医师需要对血栓风险和围术期相关出血做出正确评估,从而对患者做出合适的治疗方案。

More and more people receive long-term anticoagulation therapy as a result of stent implantations,atrial fibrillation,mechanical heart-valve replacement and deep venous thromboembolism. About 10 percentage of the population mentioned above need to take a temporary cessation when undergoing surgeries or other invasive procedures. These people have to face two problems meanwhile when they receive invasive procedures： a risk of bleeding and a risk of thromboembolic event. Specific clinical choices are different for diverse invasive procedures like elective and emergency surgeries. It is supposed for clinicians to make proper assessments of thromboembolic risk and perioperative-related bleeding in order to make an appropriate decision for the patients.