抗凝或抗血小板药物治疗患者于整形手术围术期的抗凝替代治疗方法探讨

摘要

Objective To explore a safety and effective perioperative management for patients who were having anticoagulant or antiplatelet therapy before plastic operation.Methods Totally 68 patients who continuously took anticoagulant or antiplatelet drugs before plastic operation from July 2014 to April 2016 in Beijing Anzhen Hospital,Capital Medical University were enrolled.All oral anticoagulant or antiplatelet drugs were discontinued and replaced by low molecular weight heparin(LMWH) 5 d before operation;anticoagulant or antiplatelet therapy was continued on the 1st day after operation.Wound healing and cardiovascular or cerebrovascular events were observed.Hemoglobin levels before and on the 1 st day after operation were tested.Results All wounds healed well.There were no malignant cardiovascular or cerebrovascular events.There was no significant difference in hemoglobin levels[preoperative hemoglobin:(124 ± 13) g/L,postoperative hemoglobin:(122 ± 11) g/L;P ＞ 0.05].Conclusion LMWH replacement therapy is safe and effective for patients who had anticoagulant or antiplatelet therapy before plastic surgery.%目的 探讨抗凝或抗血小板药物治疗患者于整形手术围术期的抗凝替代治疗方法.方法 收集2014年7月至2016年4月在持续抗凝或抗血小板药物治疗期间于首都医科大学附属北京安贞医院行整形外科手术的68例患者的临床资料进行回顾性分析.所有患者术前5d停用抗凝或抗血栓药物,同时皮下注射低分子肝素60 mg,1次/12 h,术前12 h停用.术后第1天恢复口服抗凝或抗血小板药物治疗.观察患者伤口愈合情况,有无局部血肿形成,有无心脑血管事件发生,记录并比较术前及术后第1天血红蛋白水平.结果 所有患者伤口均达到甲级愈合;住院期间均未发生恶性心脑血管事件;术前及术后第1天血红蛋白水平差异无统计学意义[(124±13) g/L比(122±11)g/L,P＞0.05].结论 对于口服抗凝或抗血小板药物治疗期间行整形手术的患者,围术期应用低分子肝素替代治疗是安全有效的.