#36517髋部骨折围手术期抗栓治疗的管理

Amparo Izquierdo Aicart, Maria Sempere, Alba Montoya, Rafael Badenes
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摘要

请确认已申请或授予伦理委员会批准:不相关(见本页底部信息)ESRA申请摘要奖项:我以麻醉师身份申请(年龄在35岁以下)背景和目的髋部骨折手术具有巨大的患病率和死亡率。延迟手术的主要原因之一是使用抗凝血剂/抗血小板治疗,因为这些患者年龄大且有合并症。延迟手术的风险高于手术出血或椎管血肿;因此,应在头48小时内进行及时手术。方法检索抗栓药物围手术期管理的主要指南和地方指南;重点介绍髋部骨折手术及其在神经轴向麻醉下的处理。结果-配合抗血小板药物治疗手术不应延误。在PY12抑制剂的情况下,不建议使用轴向麻醉。-使用维生素K拮抗剂治疗时,应使用维生素K/凝血酶原复合物浓缩物(PCC)进行逆转,以确保INR <1,8。当INR <1,5时可进行轴向麻醉。-使用新的口服抗凝剂(NOAC)时,建议中断时间间隔为1-2个半衰期(12-24小时不损害肾功能)。如果没有特定的凝血试验,不建议在早期手术中使用轴向麻醉。如果有进行全身麻醉的风险,我们应该考虑使用逆转剂或特定的测试。结论早期髋部骨折患者服用抗凝/抗血小板药物是安全的。神经轴麻醉的围术期时机应特别注意。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
#36517 Perioperative management of antithrombotic therapy in hip fracture surgery

Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)

Background and Aims

Hip fracture surgery has a huge prevalence and morbimortality. One of the main reasons of delaying surgery is the use of anticoagulants/antiplatelet therapies, being these patients old and with comorbidities. Risks of delay surgery are higher than surgical bleeding or vertebral canal haematoma; so promp surgery in first 48 hours should be facilitated.

Methods

In this review we search the main guidelines about perioperative management of antithrombotic drugs and locorregional guidelines; focusing in hip fracture surgery and also its management when neuroaxial anesthesia is performed.

Results

-With antiplatelet drugs therapy surgery should not be delay. In case of PY12 inhibitors neuraxial anesthesia is not recommended. -With vitamin K antagonists therapy, reversal with vitamin K/prothrombin complex concentrate (PCC) should be done for ensure INR <1,8. Neuraxial anesthesia can be performed when INR <1,5. -With new oral anticoagulants (NOAC) interruption intervals of 1-2 half-life is recommended (12-24 hours without impaired kidney function). Neuraxial anesthesia is not recommended in early surgery without a specific coagulation test. If there is a risk performing general anesthesia we should consider use of reversal agents or specific tests.

Conclusions

Early hip fracture surgery is safe in patients taking anticoagulant/antiplatelet drugs. Special attention should we pay in perioperative timing when neuraxial anesthesia is performed.
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