围术期抗血栓药物使用情况调查  

Investigation on the management of antithrombotic therapy during perioperative period

作　　者：张鸿[1] 王梓凝[2] 李怀瑾[1] 朱珊 赵宇彤 龚艳君[3] 蒋捷[3] ZHANG Hong;WANG Zi-ning;LI Huai-jin;ZHU Shan;ZHAO Yu-tong;GONG Yan-jun;JIANG Jie(Department of Anesthesiology and Critical Care Medicine,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院麻醉与重症医学科,北京100034 [2]北京大学第一医院药学部,北京100034 [3]北京大学第一医院心血管内科,北京100034

出　　处：《中国介入心脏病学杂志》2022年第1期23-28,共6页Chinese Journal of Interventional Cardiology

摘　　要：目的调查北京大学第一医院术前长期服用抗血栓药物患者的围术期药物管理情况,并分析与围术期主要不良心脑血管事件(MACCE)、出血事件相关的危险因素。方法本研究为前瞻性队列研究,收集2018年10月1日至2019年2月28日在北京大学第一医院进行外科手术、且术前长期服用抗血栓药物患者的相关信息,观察并记录围术期抗血栓药物管理情况、患者住院期间的MACCE和出血事件。结果最终有372例患者进入分析。364例(97.8%)患者在术前停用抗血栓药物,仅3例患者在进行出血低风险手术前未停药;服用阿司匹林的311例患者中,188例(60.5%)患者术前阿司匹林停药时间大于7 d;49.5%(47/95)服用P2Y12受体抑制剂的患者术前使用低分子肝素进行桥接。围术期共发生MACCE 16例(4.3%),出血事件10例(2.7%)。多因素Logistic分析发现年龄>65岁(OR 5.800,95%CI 1.243~27.070,P=0.025)、外周动脉疾病(OR 6.090,95%CI 1.380~26.878,P=0.017)和4级手术(OR 6.144,95%CI1.191~31.701,P=0.030)为围术期MACCE的独立危险因素;术前服用阿司匹林+替格瑞洛的抗血小板治疗方案(OR 14.110,95%CI 1.743~114.188,P=0.013)和手术时间(OR 1.006,95%CI 1.001~1.012,P=0.026)是围术期出血事件的独立危险因素。结论术前长期服用抗血栓药物的患者,当前围术期抗栓药物管理不够规范,需要进一步加强。对于年龄>65岁、合并外周血管疾病或拟行大手术的患者,围术期需警惕MACCE。术前采用阿司匹林联合替格瑞洛的用药方案和手术时间长是围术期出血事件的独立危险因素。Objective To investigate the perioperative management of antithrombotic drugs and to analyze the risk factors related to major adverse cardiovascular and cerebrovascular events(MACCE) and bleeding events in patients who received long-term antithrombotic drugs before surgery.Methods This study was a prospective cohort study.Patients with previous long-term use of antithrombotic drugs who underwent elective surgeries at Peking University First Hospital between October 1,2018 and February 28,2019 were enrolled.The information on perioperative management of antithrombotic drugs and the occurrences of the major adverse cardiovascular and cerebrovascular events,bleeding events and other complications during the perioperative period was recorded.Results A total of 372 patients were included in the final analysis.There were 364(97.8%) patients withdrew antithrombotic drugs before surgery and only 3 patients continued to take aspirin before low bleeding risk surgery.Among 311 patients,188(60.5%) withheld aspirin more than 7 days before surgery,while 49.5%(47/95) patients with long-term use of P2 Y;inhibitor were bridged with low molecular weight heparin brfore surgery.During the perioperative period,16 cases of MACCEs(4.3%),10 cases of bleeding events(2.7%).Multivariate Logistic analysis showed that patients more than 65 years-old(OR 5.800,95%CI1.243-27.070,P=0.025),with peripheral vascular disease(OR 6.090,95%CI 1.380-26.878,P=0.017) and degree4 surgery(OR 6.144,95%CI 1.191-31.701,P=0.030) were independent risk factors for MACCEs.Previous dual antiplatelet therapy with aspirin and ticagrelor(OR 14.110.95%CI 1.743-114.188,P=0.013) and time of surgery(OR1.006,95%CI 1.001-1.012,P=0.026) were independent risk factors for bleeding events.Condusions For patients with long-term use of antithrombotic drugs before surgery,the current perioperative management of antithrombotic drugs is not standardized.Elderly patients,those with peripheral vascular disease and patients undergoing major surgery should be alert to the occurrence of

关 键 词：抗血栓药物 围术期 主要不良心脑血管事件 出血事件 

分 类 号：R541[医药卫生—心血管疾病]