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　　圍手術(shù)期抗凝治療是一種常見的且需要考慮患者、手術(shù)和擴(kuò)大抗凝和抗血小板藥物排列的情況。術(shù)前評估必須解決的是：與圍手術(shù)期出血風(fēng)險相平衡的栓塞事件的風(fēng)險。手術(shù)操作可以分為通常不需要完全撤銷抗凝治療的低出血風(fēng)險，以及一些與中等或高出血風(fēng)險相關(guān)的操作。如果接受華法林的患者需要中斷抗凝，必需考慮的是簡單地阻斷抗凝是否是一種最佳的方法，或者是否該使用一種可替代藥物作為圍手術(shù)期的"橋接"，通常該藥物是低分子肝素。新型口服抗凝血劑達(dá)比加群和利伐沙班有更短的有效半衰期，但他們引起了圍手術(shù)期治療的其他問題，包括腎功能不全患者藥物作用時間的延長，關(guān)于確定無殘留抗凝效應(yīng)的臨床試檢測試經(jīng)驗(yàn)的有限性，且缺乏逆轉(zhuǎn)劑。圍手術(shù)期還必須考慮抗血小板藥物，還需特別考慮冠狀動脈支架患者抗血小板治療抑制期血栓并發(fā)癥的潛在風(fēng)險。相關(guān)研究見（Hematology Am Soc Hematol Educ Program. 2012; Dec.8(1):529-535.）

　　Perioperative management of patients on chronic antithrombotic therapy.

　　Ortel TL

　　1Hemostasis and Thrombosis Center, Duke University Medical Center, Durham, NC.

　　Hematology Am Soc Hematol Educ Program. 2012;2012:529-35. doi: 10.1182/asheducation-2012.1.529.

　　Abstract

　　Perioperative management of antithrombotic therapy is a situation that occurs frequently and requires consideration of the patient, the procedure, and an expanding array of anticoagulant and antiplatelet agents. Preoperative assessment must address each patient's risk for thromboembolic events balanced against the risk for perioperative bleeding. Procedures can be separated into those with a low bleeding risk, which generally do not require complete reversal of the antithrombotic therapy, and those associated with an intermediate or high bleeding risk. For patients who are receiving warfarin who need interruption of the anticoagulant, consideration must be given to whether simply withholding the anticoagulant is the optimal approach or whether a perioperative "bridge" with an alternative agent, typically a low-molecular-weight heparin, should be used. The new oral anticoagulants dabigatran and rivaroxaban have shorter effective half-lives, but they introduce other concerns for perioperative management, including prolonged drug effect in patients with renal insufficiency, limited experience with clinical laboratory testing to confirm lack of residual anticoagulant effect, and lack of a reversal agent. Antiplatelet agents must also be considered in the perioperative setting, with particular consideration given to the potential risk for thrombotic complications in patients with coronary artery stents who have antiplatelet therapy withheld.