髋部骨折患者的术后管理和抗凝或抗凝药物治疗。SEDAR止血科的协商一致建议

IF 0.8 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion Pub Date : 2025-01-01 DOI:10.1016/j.redar.2024.501651

C. Cassinello , R. Ferrandis , A. Gómez-Luque , F. Hidalgo , J.V. Llau , G. Yanes-Vidal , P. Sierra

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引用次数: 0

摘要

背景：抗凝和抗凝治疗使骨质疏松性髋部骨折患者的治疗复杂化。方法SEDAR止血组成立工作组，制定骨质疏松性髋部骨折患者抗凝或抗凝治疗的行动计划。所提出的建议以最佳做法的证据为基础，并已由6个专业组成的多学科小组进行了验证。结果早期手术减少了并发症和死亡率，改善了患者的舒适度和功能恢复，硬膜内麻醉和全身麻醉的死亡率无差异。结论虽然存在不确定性，但建议在入院后24-48小时内进行手术，并根据止血情况调整周围神经阻滞和麻醉类型（轴向或全身）。多模式管理抗血栓药物，止血，血红蛋白和静脉血栓预防自入院以来的优化建议。

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Manejo perioperatorio del paciente con fractura de cadera y tratamiento con fármacos anticoagulantes o antiagregantes. Recomendaciones de consenso de la sección de hemostasia de la SEDAR

Background

Antiaggregant and anticoagulant therapy complicate the management of patients with osteoporotic hip fracture.

Methods

The haemostasis section of SEDAR established a working group to define an action plan for the management of antiaggregated or anticoagulated patients with an osteoporotic hip fracture. The suggested recommendations are based on evidence of best practices, and have been validated by a multidisciplinary group formed by 6 specialties.

Results

Early surgery reduces complications and mortality and improves patient comfort and functional recovery, with no difference in mortality between intradural and general anaesthesia.

Conclusions

Although uncertainties remain, it is recommended to perform surgery within 24-48 hours of admission, adapting peripheral nerve blocks and type of anesthesia (neuraxial or general) an to the haemostatic conditions. A multimodal management of antithrombotics, and the optimisation of haemostasis, haemoglobin and venous thromboprophylaxis since admission are suggested.

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