神经外科术前停用阿司匹林与围术期出血和缺血事件风险

doi:10.16352/j.issn.1001-6325.2022.02.015

基础医学与临床 ›› 2022, Vol. 42 ›› Issue (2): 330-334.doi: 10.16352/j.issn.1001-6325.2022.02.015

神经外科术前停用阿司匹林与围术期出血和缺血事件风险

王鑫焱, 王昕馨, 于芸, 韩如泉^*

首都医科大学附属北京天坛医院麻醉科,北京 100070

收稿日期:2021-09-14 修回日期:2021-12-06 发布日期:2022-01-24
通讯作者: ^* ruquan.han@ccmu.edu.cn
基金资助:
北京市医院管理局“登峰”人才培养计划(DFL20180502);北京市医院管局重点医学专业发展计划(ZYLX201708)

Association between discontinuation of aspirin and perioperative bleeding or ischemic events before neurosurgery

WANG Xin-yan, WANG Xin-xin, YU Yun, HAN Ru-quan^*

1. Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China

Received:2021-09-14 Revised:2021-12-06 Published:2022-01-24
Contact: ^* ruquan.han@ccmu.edu.cn

摘要/Abstract

摘要： 围术期停用阿司匹林带来的问题是患者处于高凝状态,从而增加血管栓塞事件的发生,但如果继续使用,可能会增加出血风险。本文主要就神经外科术前是否停用阿司匹林的出血和缺血风险进行综述,以便指导临床。

关键词: 阿司匹林, 出血, 缺血, 神经外科

Abstract: The problem with discontinuation of aspirin during the perioperative period is that the patient is in a hypercoagulable state, which increases the occurrence of embolism event. However, continued use during the perioperative period may increase the risk of bleeding. This article reviews the bleeding and ischemic risks of stop use aspirin before neurosurgery, in order to guide the clinical practice.

Key words: aspirin, bleeding, ischemia, neurosurgery

中图分类号:

R973+.2

王鑫焱, 王昕馨, 于芸, 韩如泉. 神经外科术前停用阿司匹林与围术期出血和缺血事件风险[J]. 基础医学与临床, 2022, 42(2): 330-334.

WANG Xin-yan, WANG Xin-xin, YU Yun, HAN Ru-quan. Association between discontinuation of aspirin and perioperative bleeding or ischemic events before neurosurgery[J]. Basic & Clinical Medicine, 2022, 42(2): 330-334.

参考文献

[1]Patrono C, Morais J, Baigent C, et al.Antiplatelet agents for the treatment and prevention of coronary Atherothrombosis[J].J Am Coll Cardiol,2017,70:1760-1776.
[2]Montinari MR, Minelli S, De Caterina R. The first 3 500 years of aspirin history from its roots-a concise summary[J].Vascul Pharmacol,2019,113:1-8.
[3]Weiser TG, Haynes AB, Molina G, et al.Size and distribution of the global volume of surgery in 2012[J].Bull World Health Organ,2016,94:201-209.
[4]Rose J, Weiser TG, Hider P, et al.Estimated need for surgery worldwide based on prevalence of diseases: a modelling strategy for the WHO Global Health Estimate[J].Lancet Glob Health,2015,3 Suppl 2(Suppl 2):S13-20.
[5]Lewis SR, Pritchard MW, Schofield-Robinson OJ, et al.Continuation versus discontinuation of antiplatelet therapy for bleeding and ischaemic events in adults undergoing non-cardiac surgery[J].Cochrane Database Syst Rev,2018,7:Cd012584. doi:10.1002/14651858.CD012584.pub2.
[6]Chan FKL, Kyaw MH, Hsiang JC, et al.Risk of postpolypectomy bleeding with uninterrupted clopidogrel therapy in an industry-independent, double-blind, randomized trial[J].Gastroenterology,2019,156:918-925.
[7]Cheng A, Poon MTC,Demetriades AK.Aspirin therapy discontinuation and intraoperative blood loss in spinal surgery: a systematic review[J].Neurosurg Rev,2018,41:1029-1036.
[8]Mitchell JA, Kirkby NS, Ahmetaj-Shala B, et al.Cyclooxygenases and the cardiovascular system[J].Pharmacol Ther,2021,217:107624. doi:10.1016/j.pharmthera.2020.107624.
[9]赵艳秋,梁伟, 洪玉娥. 老年患者阿司匹林抵抗发生率及其相关危险因素分析[J].基础医学与临床,2021,41:1035-1038.
[10]Wang Y, Wang Y, Zhao X, et al.Clopidogrel with aspirin in acute minor stroke or transient ischemic attack[J].N Engl J Med,2013,369:11-19.
[11]Wang Y, Meng X, Wang A, et al.Ticagrelor versus clopidogrel in CYP2C19 loss-of-function carriers with stroke or TIA[J].N Engl J Med,2021. doi: 10.1056/NEJMoa2111749.
[12]Burn J, Sheth H, Elliott F, et al.Cancer prevention with aspirin in hereditary colorectal cancer (Lynch syndrome), 10-year follow-up and registry-based 20-year data in the CAPP2 study: a double-blind, randomised, placebo-controlled trial[J].Lancet,2020,395:1855-1863.
[13]Columbo JA, Lambour AJ, Sundling RA, et al.A Meta-analysis of the impact of aspirin, clopidogrel, and dual antiplatelet therapy on bleeding complications in noncar-diac surgery[J].Ann Surg,2018,267:1-10.
[14]韦敏,钟海燕,都义日,等.腹腔镜手术老年患者围术期停用阿司匹林的风险-收益评价[J].中华麻醉学杂志,2019,5:526-529.
[15]Antolovic D, Rakow A, Contin P, et al.A randomised controlled pilot trial to evaluate and optimize the use of anti-platelet agents in the perioperative management in patients undergoing general and abdominal surgery--the APAP trial (ISRCTN45810007)[J].Langenbecks Arch Surg,2012,397:297-306.
[16]Chu EW, Chernoguz A, Divino CM.The evaluation of clopidogrel use in perioperative general surgery patients: a prospective randomized controlled trial[J].Am J Surg,2016,211:1019-1025.
[17]Mantz J, Samama CM, Tubach F, et al.Impact of preoperative maintenance or interruption of aspirin on thrombotic and bleeding events after elective non-cardiac surgery: the multicentre, randomized, blinded, placebo-controlled, STRATAGEM trial[J].Br J Anaesth,2011,107:899-910.
[18]Bogunovic L, Haas AK, Brophy RH, et al.The perioperative continuation of aspirin in patients undergoing arthroscopic surgery of the knee[J].Am J Sports Med,2019,47:2138-2142.
[19]王梓,夏利民,宋凯,等. 不停跳冠状动脉旁路移植术前停用阿司匹林及氯吡格雷对术后出血和输血的影响[J].中华外科杂志,2019,3:187-193.
[20]Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses[J].Eur J Epidemiol,2010,25:603-605.
[21]Scerrati A, Germanò A, Trevisi G, et al.Timing of low-dose aspirin discontinuation and the influence on clinical outcome of patients undergoing surgery for chronic subdural hematoma[J].World Neurosurg,2019,129:e695-e699. doi: 10.1016/j.wneu.2019.05.252.
[22]Lee AT, Gagnidze A, Pan SR, et al.Preoperative low-dose aspirin exposure and outcomes after emergency neurosurgery for traumatic intracranial hemorrhage in elderly patients[J].Anesth Analg,2017,125:514-520.
[23]Cuellar JM, Petrizzo A, Vaswani R, et al.Does aspirin administration increase perioperative morbidity in patients with cardiac stents undergoing spinal surgery?[J].Spine (Phila Pa 1976),2015,40:629-635.
[24]Park HJ, Kwon KY, Woo JH.Comparison of blood loss according to use of aspirin in lumbar fusion patients[J].Eur Spine J,2014,23:1777-1782.
[25]Soleman J, Baumgarten P, Perrig WN, et al.Non-instrumented extradural lumbar spine surgery under low-dose acetylsalicylic acid: a comparative risk analysis study[J].Eur Spine J,2016,25:732-739.

神经外科术前停用阿司匹林与围术期出血和缺血事件风险

Association between discontinuation of aspirin and perioperative bleeding or ischemic events before neurosurgery

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	甄磊, 张懿兰, 王晓娜, 张小琼. 瑞马唑仑减轻心肌缺血/再灌注大鼠心肌损伤[J]. 基础医学与临床, 2024, 44(9): 1243-1248.
[2]	汪丹, 王李傲, 马顺昌, 贾旺, 李德岭. 基于“神经外科基本操作及手术入路”精品示范课程的专业学位教育实践[J]. 基础医学与临床, 2024, 44(9): 1320-1323.
[3]	张祥鑫, 李文. 线粒体自噬在肝脏缺血再灌注损伤中的作用[J]. 基础医学与临床, 2024, 44(6): 877-881.
[4]	刘振磊, 菅凤增, 吴浩. 神经外科专业型研究生科研能力现状调查与分析[J]. 基础医学与临床, 2024, 44(5): 733-737.
[5]	秦小英, 刘慧, 韩冲芳, 贺建东. 改善昼夜节律紊乱减轻糖尿病大鼠心肌缺血/再灌注损伤[J]. 基础医学与临床, 2024, 44(2): 231-234.
[6]	冯雪岩, 熊云云, 王利圆, 曹智鑫, 郝曼均, 宗黎霞, 王上. 颅外动脉狭窄不同干预方案联合机械取栓治疗前循环串联病变的再灌注效果[J]. 基础医学与临床, 2024, 44(10): 1388-1393.
[7]	王琼, 董倩兰, 朱燕亭, 金刚, 张琳萍. 桔梗皂苷D减轻大鼠肾缺血/再灌注损伤[J]. 基础医学与临床, 2023, 43(8): 1222-1228.
[8]	吴蓓, 杨柳, 韩如泉. 成人先天性心脏病患者神经外科围手术期管理[J]. 基础医学与临床, 2023, 43(7): 1138-1142.
[9]	杨为祝, 刘忠, 张峰林, 黄延林, 孙瑾, 田新华. NOX4介导的氧化应激参与垂体腺瘤出血性卒中的发生[J]. 基础医学与临床, 2023, 43(7): 1040-1044.
[10]	录亚鹏, 谢建琴. NLRP3炎性小体在缺血再灌注损伤治疗中作用的研究进展[J]. 基础医学与临床, 2023, 43(4): 706-710.
[11]	曲大鹏, 孙会艳, 李强, 王洪权. 铁死亡在蛛网膜下腔出血早期脑损伤发病机制中作用的研究进展[J]. 基础医学与临床, 2023, 43(3): 486-489.
[12]	李雨喋, 王宏宇, 韩松, 李俊发. 激活素A通过少突胶质细胞ACVR1C改善缺血性卒中小鼠神经功能的预后[J]. 基础医学与临床, 2023, 43(3): 380-385.
[13]	袁培根, 陈顺利, 单鸳露, 薛彬彬, 叶玉柱, 林丽娜. 艾司氯胺酮减轻大鼠骨骼肌缺血再灌注损伤[J]. 基础医学与临床, 2023, 43(12): 1822-1826.
[14]	马聪聪, 刘洋, 吕洋, 王海萍. 线粒体自噬在心肌缺血/再灌注损伤中的作用研究进展[J]. 基础医学与临床, 2023, 43(11): 1723-1727.
[15]	郭丽苹, 苏娟, 田新雁, 陆丽, 胡亚荣, 秦燕. 骨桥蛋白在大鼠肝缺血/再灌注损伤中的作用[J]. 基础医学与临床, 2023, 43(1): 83-86.