接受抗凝及抗血小板治疗患者的围手术期处理决策

Perioperative Management of Patients Receiving Anticoagulant and Antiplatelet Therapy

近年来,日益增多的临床研究为接受抗凝及抗血小板治疗患者围手术期处理提供了良好借鉴。对于传统抗凝治疗,部分心房颤动患者的手术可在持续抗凝的情况下进行,大多数心房颤动患者可避免选用肝素桥接抗凝,而机械性心脏瓣膜患者的肝素桥接抗凝效应有待进一步验证。此外,需要综合评估患者出血风险、肾功能及药动学以制订新型口服抗凝药的管理方案。对于抗血小板治疗主要依据药物对血小板功能抑制的逆转时间来确定手术时机。总之,实现个体化精准管理并开展更多高质量临床研究是未来工作的重点。

In recent years,increasing clinical study provide a good reference for perioperative management of patients receiving anticoagulant or antiplatelet therapy.In terms of traditional anticoagulant therapy,the operation of some patients with atrial fibrillation can be carried out under the condition of consistent anticoagulation,while most of the patients can avoid heparin bridging anticoagulation,and the heparin bridging anticoagulant effect on patients with mechanical heart valve needs to be further verified.In addition,it is necessary to comprehensively evaluate the patient′s bleeding risk,renal function and pharmacokinetics in order to formulate the management scheme of new oral anticoagulants.In terms of antiplatelet therapy,the timing of operation is mainly determined according to the reversal time of drug inhibition of platelet function.In short,realizing individua-lized and accurate management and carrying out more high-quality clinical research are the focus of the future work.