非心脏外科手术患者围术期抗血栓药物使用单中心调查  

Perioperative antithrombotic medication use in non-cardiac surgery:a single center survey

作　　者：董彬彬 赵宇彤 王梓凝[3] 李怀瑾[4] 朱珊 张鸿[4] 龚艳君[1] 蒋捷[1] DONG Bin-bin;ZHAO Yu-tong;WANG Zi-ning;LI Huai-jin;ZHU Shan;ZHANG Hong;GONG Yan-jun;JIANG Jie(Department of Cadiology,Peking University First Hospital,Beijing 100034,China;Department of Cadiology,Beijing Tsinghua Changgung Hospital,Beijing 102218,China;Department of Pharmacy,Peking University First Hospital,Beijing 100034,China;Department of Anesthesiology,Peking University First Hospital,Beijing 100034,China;Department of Anesthesiology,the First Affi liated Hospital of Xi’an Jiaotong University,Xi’an 710061,China)

机构地区：[1]北京大学第一医院心血管内科,北京100034 [2]北京清华长庚医院心血管内科,北京102218 [3]北京大学第一医院药学部,北京100034 [4]北京大学第一医院麻醉与重症医学科,北京100034 [5]西安交通大学第一附属医院麻醉科,陕西西安710061

出　　处：《中国介入心脏病学杂志》2025年第4期181-188,共8页Chinese Journal of Interventional Cardiology

摘　　要：目的调查术前长期服用抗血栓药物患者的围术期药物使用情况。方法纳入2018年10月1日至2019年2月28日在北京大学第一医院住院行非心脏外科手术治疗、术前长期服用抗血栓药物的患者,通过患者和医师访谈,了解围术期抗血栓药物使用方案,与《抗血栓药物围手术期管理多学科专家共识》(以下简称《共识》)对比,评价治疗方案的规范性,并分析其影响因素。结果最终纳入372例进行分析,其中355例长期仅口服抗血小板药物,17例长期口服抗凝药物。364例(97.8%)患者在术前停用抗血栓药物;109例(29.3%)患者术前使用低分子肝素桥接。在355例口服抗血小板药物患者中,108例(30.4%)停药时间与《共识》推荐相一致,186例(52.4%)停药时间较长;术后平均在院时间6.64 d,在院期间恢复用药比例仅为37例(10.4%)。17例服用抗凝药物的患者术后平均在院时间9.94 d,在院期间恢复用药比例为2例(11.8%)。在围术期风险评估方面,评估停药血栓风险时,仅40例(10.8%)患者进行了额外内科诊疗评估,其余均为外科医师评估。冠心病(OR 2.851,95%CI 1.160~7.011,P=0.022)为接受内科评估的独立影响因素。对于出血风险的评估,在68.0%的患者中外科医师评估结果与《共识》推荐相一致,而在32.0%的患者中不一致,外科医师的评估倾向于低危。结论非心脏外科手术围术期抗血栓治疗方案与《共识》的一致率低,抗血栓药物术前停药时间长,低分子肝素桥接比例高,术后院内恢复用药比例低。Objective To investigate the perioperative management of antithrombotic drugs in patients undergoing non-cardiac surgery.Methods Patients on long-term antithrombotic drugs who underwent non-cardiac surgery in our hospital were included.Through interviews with patients and physi cians,perioperative antithrombotic medication regimens were reviewed and compared with the“Multidisciplinary Expert Consensus on Perioperative Management of Antithrombotic Therapy”4to evaluate compliance with consensus and analyze influencing factors.Results A total of 372 patients were included in the analysis.Among them,355 patients were on long-term antiplatelet therapy alone,and 17 were on long-term oral anticoagulantion.364(97.8%)discontinued antithrombotic medications prior to surgery.109 patients(29.3%)received low molecular weight heparin(LMWH)bridging therapy.Among the 355 patients on antiplatelet therapy,108(30.4%)had discontinuation durations consistent w ith the consensus recommendations,while 186(52.4%)discontinued medications for longer periods.Postoperatively,the average hospital stay for antiplatelet therapy patients was 6.64 days,with only 37(10.4%)resuming therapy during hospitalization.The average hospital stay for patients on anticoagulants was 9.94 days,with only 2(11.8%)resuming therapy during hospitalization.Regarding perioperative risk assessment,only 40(10.8%)of patients underwent additional internal medical evaluation for thromboembolic risk after medication discontinuation,with the remainder assessed soly by surgeons.Coronary heart disease was an independent risk factor associated with internal medical evaluation(OR 2.851,95%CI 1.160–7.011,P=0.022).For bleeding risk assessment,surgeons evaluations aligned with the consensus in 68.0%of cases,but surgeons tended to underestimate risk compared to the consensus.Conclusions In this single-center study,perioperative antithrombotic management showed low compliance with expert consensus,characterized by prolonged preoperative medication discontinuation,high rates o

关 键 词：抗血栓药物 围术期策略 桥接治疗 非心脏手术 

分 类 号：R5[医药卫生—内科学]