手術前後抗血栓藥品使用原則

Principles of Perioperative Antithrombotic Therapy

曾如慧(Ju-Huei Tesng) ； 張瑞家(Jui-Chia Chang)

《北市醫學雜誌》 15卷2期 (2018/06) Pp. 28-38

https://doi.org/10.6200/TCMJ.201806_15(2).0004

摘要

本文彙整使用抗血栓藥品病人，進行常規手術時的藥品使用通則：（1）依據不同適應症與危險因子評估栓塞風險，若病人處於高栓塞風險期，應盡量推延手術時間，直到度過高風險期；（2）出血風險依手術種類而異，例如：出血風險極低的單顆拔牙手術，可不停藥；高出血風險手術，warfarin建議術前5天停藥，新型口服抗凝血劑建議停藥4-5個半衰期，抗血小板凝集劑依種類停藥2-7天不等；（3）於warfarin停藥期間有高栓塞風險的病人，應考慮使用肝素橋接；（4）若病人本身存在其他會增加栓塞或出血風險的因子，則應進一步考慮個別化減少或增加停藥天數。（5）為使栓塞、出血併發症降至最低，抗血栓藥品處方醫師與執行手術醫師應共同討論出血與栓塞風險以決定停藥與恢復啟用的時間。

關鍵字

抗凝血劑 ； 抗血小板凝集劑 ； 手術期間 ； 停藥

並列摘要

In this article, we gathered and summarized the general recommendations for antithrombotic therapy in patients requiring an elective surgery. First, determine the thrombotic risk according to indication and contribution factors. Surgery should be delayed until the high risk period is over. Second, the risk of thrombosis varies across types of surgery. For example, antithrombotic agents can be continued during procedures with minimal bleeding risks, such as single tooth extraction. For procedures with high bleeding risks, stopping warfarin for five days, novel anticoagulants for four to five halflives or antiplatelets for two to seven days prior to procedures, is recommended. Third, heparin bridging therapy should be considered in patients with high thrombotic risks during the interruption of warfarin. Fourth, if there are additional bleeding or thrombotic risk factors, adjustment of the duration of antithrombotic discontinuation, either increase or decrease, should be considered individually. Fifth, to minimize the bleeding and thrombotic complications, operating surgeons and antithrombotic prescribers should evaluate the risks of bleeding and thrombosis together to decide the timing of antithrombotic interruption and resumption for the patients.

並列關鍵字

anticoagulant ； antiplatelet ； perioperative ； interruption