术前服用波立维该如何调整
本帖最后由 糖糖不次糖 于 2024-7-1 22:36 编辑以下文章来源于老李飞麻，作者老李飞麻
抗血小板药物现在用的是非常广泛，特别是阿司匹林，简直是有病没病吃一点，年纪大吃一点，高血压吃一点，高龄产妇吃一点，更不要说是冠脉支架术后或者血栓栓塞高风险病人了。但这样的病人在行非心脏手术时如何调整用药，如何平衡出血与血栓风险，值得探讨。美国胸科医师协会（ACCP）近期更新围手术期抗血小板指南，并给出一张简洁明了的图，详细指南如下：
（1）Management of Antiplatelet Drugs Around Minor Procedures (Dental, Dermatologic, Ophthalmologic)，we suggest continuing the antiplateletdrug (ASA or P2Y12 inhibitor) over stopping the antiplatelet agent before the procedure. Patients who are receiving dual antiplatelet therapy with ASA and a P2Y12 inhibitor can continue ASA and interrupt the P2Y12 inhibitor.（小手术例如皮肤科，眼科，牙科等小手术，如仅服用ASA 或P2Y12抑制剂，可不停用，如合用ASA和P2Y12，可停用其中任何一种）
（2）In patients receiving ASA who are undergoing elective non-cardiac surgery,we suggest ASA continuation over ASA interruption. In patients receiving ASA therapy whoare undergoing elective surgery and require ASA interruption, we suggeststopping ASA ＜7 days instead of 7 to 10 days before the surgery. Inpatients receiving clopidogrel who are undergoing an elective non-cardiacsurgery, we suggest stopping clopidogrel 5 days instead of 7 to 10 days beforethe surgery, stopping ticagrelor 3 to 5 daysinstead of 7 to 10 days before the surgery, stopping prasugrel 7 days instead of 7to 10 days before the surgery.In patients who require antiplatelet drug interruption we suggest to resume antiplatelet drugs ＜24 hours instead of > 24 hours after the surgery/procedure.（不建议在术前停用阿司匹林（颅内手术，脊柱手术除外），如必须停用，可停用＜7天，如服用波立维，只需停用五天，替卡格雷只需停用3-5天，普拉格雷停用7天，并在手术结束后24小时即可恢复使用）
（3）In patients receiving antiplatelet drug therapy who areundergoing an elective surgery/procedure, we suggest against the routine use ofplatelet function testing prior to the surgery/procedure to guide perioperativeantiplatelet management（围手术期没必要监测血小板功能）
（4）In patients receiving ASA and a P2Y12 inhibitor withcoronary stents placed within the last 6 to 12 weeks who are undergoing anelective surgery, we suggest either continuation of both antiplateletagents or stopping one antiplatelet agent within 7 to 10 days of surgery. within the last 3 to 12 months and are undergoing anelective surgery, we suggest stopping the P2Y12 inhibitor prior tosurgery over continuation of the P2Y12 inhibitor（冠脉支架植入后6-12周患者服用阿司匹林与P2Y12抑制剂患者，建议停用其中一种药物7-10天，也可不必停药。冠脉支架植入后3-12月，我们建议停用P2Y12抑制剂）
（5）In patients with coronary stents who require continueddual antiplatelet therapy, we suggest delaying an elective surgery/procedureover not delaying the surgery/procedure. In patients with coronary stents who require interruption of antiplatelet drugs for an elective surgery, we suggest against routine bridging therapy with a glycoprotein IIb/IIIa inhibitor, cangrelor, or LMWH over routine use of bridging therapy（择期手术患者不能停用双抗者，建议延期手术。如必须手术，不建议使用IIb/IIIa受体拮抗剂，低分子肝素等桥接，而使用常规肝素桥接）
往期推荐：常见抗血栓药物的停药及桥接策略《NEJM循证》综述 | 抗凝和抗血小板疗法的围手术期管理
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