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EUR HEART J :口服抗凝剂停用多久仍可维持手术所需药效?

2017-07-26 MedSci MedSci原创

直接口服抗凝剂(DOACs)治疗的患者经常进行选择性侵入性手术。近日,在医学权威杂志EUR HEART J上面发表了一篇研究文章,研究人员旨在确定DOAC停用的药效最佳持续时间,以确保在手术过程中有最低的抗凝效果。

直接口服抗凝剂(DOACs)治疗的患者经常进行选择性侵入性手术。近日,在医学权威杂志EUR HEART J上面发表了一篇研究文章,研究人员旨在确定DOAC停用的药效最佳持续时间,以确保在手术过程中有最低的抗凝效果。

研究人员采用前瞻性、多中心队列研究,纳入了422名需要侵入性手术的经DOAC治疗患者。这些受试者进行术前DOAC浓度([DOAC])和常规止血法试验,以确定:i.根据DOAC停用后药效持续时间,病人达到术前最小DOAC浓度(≤30 ng/mL)的比例;ii.[DOAC]的最低浓度的预测因子,iii .常规止血法试验预测[DOAC]的最低浓度。最后,研究人员对围手术期出血事件的预测因子进行了评估。

DOAC停用后药效持续时间范围从1到218 h;术前[DOAC]浓度从≤30到527 ng/mL。49-72 h后停药,95%的(DOAC)≤30 ng/mL。停用72 h的预测浓度≤30 ng/mL,特异性为91%。在多变量分析中,DOAC停用后药效持续时间,肌酐清除率< 50 mL/min,抗心律不变性是术前最小[DOAC]浓度的独立预测因子(匹配统计量:0.869;95%置信区间:0.829-0.912)。相反,常规止血法是不准确的预测因子。最后,肌酐清除率<50 mL/min,抗血小板和高出血风险手术是出血事件的预测因子。

由此可见,DOAC摄入的最后时间为术前3天,几乎所有患者都达到了手术要求的最低抗凝效果。中度肾功能损害(尤其是在达比加群酯治疗的患者),以及抗Xa抗心律失常药物治疗的患中会导致DOAC停用后药效持续时间更持久。在需要检测抗凝血药浓度的情况下,常规止血法不应取代DOAC浓度检测法。

原始出处

Anne Godier,Anne-Sophie Dincq,Anne-Céline Martin,et al. Predictors of pre-procedural concentrations of direct oral anticoagulants:a prospective multicentre study. EUR HEART J. 2017 July.

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    2018-03-05 lsndxfj
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    2017-07-27 zhaojie88
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    2017-07-27 slcumt
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