Eur Spine J:腰椎手术患者使用aspirin会增加出血风险

2014-08-18 紫川秀第二 童勇骏 丁香园

阿司匹林是一类NSAIDs类药物,在临床中较长应用于心血管疾病的预防,也有临床医生将阿司匹林作为血栓的预防用药,并且也取得了不错的效果。随着使用阿司匹林类药物的人群越来越多,其在临床择期手术中的问题开始凸显:即,对使用阿司匹林作为预防药物的患者,在择期手术中是否需要预先停用阿司匹林来减少其可能带来的术后出血风险。早前在spine上也有一篇文献报道,认为在脊柱后路手术过程中,使用阿司匹林作为预防用药

阿司匹林是一类NSAIDs类药物,在临床中较长应用于心血管疾病的预防,也有临床医生将阿司匹林作为血栓的预防用药,并且也取得了不错的效果。随着使用阿司匹林类药物的人群越来越多,其在临床择期手术中的问题开始凸显:即,对使用阿司匹林作为预防药物的患者,在择期手术中是否需要预先停用阿司匹林来减少其可能带来的术后出血风险。

早前在spine上也有一篇文献报道,认为在脊柱后路手术过程中,使用阿司匹林作为预防用药的患者,在术前1周内停用阿司匹林可以显著降低术后引流出血量。就此文我给Spine杂志去过一封letter,其中核心观点是:对高危患者,择期手术不应停止阿司匹林的使用,因其停用阿司匹林可能诱发的心血管事件后果的严重性是要高于术后引流出血增多的风险。

相关阅读:Spine:择期腰椎融合术前7-10天为阿司匹林最佳停药时间

近期,韩国学者Heui等人完成的相关研究进一步证实了术前应用阿司匹林会增加择期手术后出血的风险,但在他们的论文中也强调了我一直以来的观点:对有高危风险的患者,择期手术不应停用阿司匹林。

研究者调查了106例2节段以上脊柱手术的患者,将患者按照术前是否使用阿司匹林,和术前停用阿司匹林的时间分为三组:组A,不适用阿司匹林的患者;组B,术前一周停用阿司匹林的患者;组C,未停用阿司匹林的患者。计算患者术后失血,并评估患者血小板功能状态。

结果发现,若不将NSAIDs类药物使用考虑在内,三组患者组间失血比较无差异;而若将NSAIDs类药物使用考虑在内,则组2和组3的失血显著高于组1;血小板功能在组别间无显著差异。

作者在结论中分析,脊柱两节段以上融合术患者,术前使用阿司匹林会显著增加出血风险,即便该患者在术前1周停止服用阿司匹林也不会减低出血的风险。对停用阿司匹林有较高风险的患者,在腰部择期手术中应当继续使用。但是需要严格评估其可能存在的术后出血风险。后期需要进一步明确,对低危患者较为合适的阿司匹林停用周期。

原始出处:


Park HJ1, Kwon KY, Woo JH.Comparison of blood loss according to use of aspirin in lumbar fusion patients.Eur Spine J. 2014 Aug;23(8):1777-82. doi: 10.1007/s00586-014-3294-y. Epub 2014 Apr 17.

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    2015-02-01 mgqwxj
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