Cerrahi planlanan hastalarda antikoagülan ve antiagregan tedavinin yönetimi

Öz

Günümüzde yaşlanan toplumun sonucu olarak hem kardiyovasküler hastalıkların sıklığında hem de toplumun cerrahi operasyon ihtiyacında artış olmaktadır. Özellikle son bir yıl içerisinde farklı sebeplerle ikili antiplatelet veya antikoagülan ilaç kullanan hastalarda, bu ilaçların uygunsuz kesilmesi trombotik komplikasyonları arttırmakta, tedavinin işlem öncesi düzenlenmemesi de kanama riskini ciddi düzeyde arttırmaktadır. Bu yazıda, kalp dışı cerrahi planlanan hastalarda antikoagülan ve antiagregan tedavinin nasıl düzenleneceğinden kısaca bahsedilecektir.

Anahtar Kelimeler

• cerrahi
• preoperatif
• antikoagülan
• antiagregan
• antitrombotik

Management of anticoagulant and antiplatelet therapy in patients scheduled for surgery

Öz

With the aging population, there is a rising incidence of both cardiovascular diseases and the need for surgical operations in society. Especially in patients receiving dual antiplatelet or anticoagulant therapy for various reasons within the last year, inappropriate discontinuation of these drugs increases thrombotic complications, while failure to manage the treatment prior to the procedure significantly increases the risk of bleeding. This article briefly discusses how to manage anticoagulant and antiplatelet therapy in patients scheduled for non-cardiac surgery.

Anahtar Kelimeler

• surgery
• preoperative
• anticoagulant
• antiplatelet (antiaggregant)
• antithrombotic

Destekleyen Kurum

none

Teşekkür

none

Kaynakça

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2. Smilowitz NR, Gupta N, Guo Y, Beckman JA, Bangalore S, Berger JS. Trends in cardiovascular risk factor and disease prevalence in patients undergoing non-cardiac surgery. Heart 2018; 104: 1180-6. 
3. Halvorsen S, Mehilli J, Cassese S, Hall TS, Abdelhamid M, Barbato E et al. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. Eur Heart J 2022; 43: 3826-924. 
4. Beyer-Westendorf J, Gelbricht V, Förster K, Ebertz F, Köhler C, Werth S et al. Peri-interventional management of novel oral anticoagulants in daily care: results from the prospective Dresden NOAC registry. Eur Heart J 2014; 35:1888-96.
5. Douketis JD, Spyropoulos AC, Murad MH, Arcelus JI, Dager WE, Dunn AS et al. Perioperative Management of Antithrombotic Therapy: An American College of Chest Physicians Clinical Practice Guideline. Chest 2022; 162: e207-e243.
6. Kuo HC, Liu FL, Chen JT, Cherng YG, Tam KW, Tai YH. Thromboembolic and bleeding risk of periprocedural bridging anticoagulation: A systematic review and meta-analysis. Clin Cardiol 2020; 43: 441-9.
7. Levy JH, Ageno W, Chan NC, Crowther M, Verhamme P, Weitz JI; Subcommittee on Control of Anticoagulation. When and how to use antidotes for the reversal of direct oral anticoagulants: guidance from the SSC of the ISTH. J Thromb Haemost 2016; 14: 623-7.
8. Graham MM, Sessler DI, Parlow JL, Biccard BM, Guyatt G, Leslie K et al. Aspirin in Patients With Previous Percutaneous Coronary Intervention Undergoing Noncardiac Surgery. Ann Intern Med 2018; 168: 237-44. 

9. Valgimigli M, Bueno H, Byrne RA, Collet JP, Costa F, Jeppsson A et al; ESC Scientific Document Group; ESC Committee for Practice Guidelines (CPG); ESC National Cardiac Societies. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2018; 39: 213-60.