Antiagregan İlaç Kullanan Hastalarda Sistoskopi ve Sistostomi Operasyonu: Hasta Hazırlık ve Takip Süreci
Özet
Antiagregan ilaçlar arterlerde daha çok olmak üzere trombositleri agregasyonunu inhibe eden ajanlardır.Bu ajanlar aspirin ve aspirinden sonra sıklıkla kullanılan klopidogrel ,tikagrelor, prasuguel, tiklodipin ve tirofiban, absiksimab, Dipiridamol gibi ilaçlardır.
Aspirin düşük dozda COX-1 enzimini irrevesibl inhibe eder.Tromboksan A2 sentezini önleyerek antiagregan etki yapar .Klopidpogrel , prasuguel ,tiklodipin trombositlerde ADP’nin P2Y12 reseptörlerini irrevesibl inhibe ederek antiagregan etki yaparlar.Klopidogrel ayrıca ön ilaçtır.CYP2C19 ile aktifleşir.Tikagrelor antiagregasyon işlevini aynı şekilde fakat reversibl olarak gerçekleştirir.
Tirofiban , glikoprotein 2b/ 3a reseptörlerini inhibe ederek antiagregasyon etkisi yapar.
Dipiridamol ise trombositlere adenozin alımını azaltarak trombosit agregasyonunu inhibe eder ve böylece adenozin difosfat (ADP) ve trombosit aktive edici faktör (PAF) üretimini azaltır.
Bu ajanlardan tirofiban sadece iv, dipiridamol hem oral hem de iv diğer ajanlar ise oral olarak kullanılmaktadır. (1)Bu ajanlar haricinde daha birçok fakat daha az sıklıkla kullanılan antiagregan ilaçlar bulunmaktadır.Bu ilaçları kullanan hastalarda acil veya elektif şartlarda operasyon gerekli olabilmektedir.
Antiplatelet drugs inhibit platelet aggregation, particularly in arteries, and include aspirin, clopidogrel, ticagrelor, prasugrel, ticlopidine, tirofiban, abciximab, and dipyridamole.
Aspirin irreversibly inhibits the COX-1 enzyme, preventing thromboxane A2 synthesis. Clopidogrel, prasugrel, and ticlopidine irreversibly block the P2Y12 ADP receptors on platelets, with clopidogrel acting as a prodrug activated by CYP2C19. Ticagrelor provides a reversible antiplatelet effect. Tirofiban inhibits glycoprotein IIb/IIIa receptors, while dipyridamole reduces platelet aggregation by decreasing adenosine uptake, thus lowering ADP and platelet-activating factor production.
Tirofiban is administered intravenously, dipyridamole can be given both orally and intravenously, while the other agents are primarily oral. Various less commonly used antiplatelet drugs also exist, and patients on these medications may require surgical interventions in emergency or elective settings.
Referanslar
Ellis G, John Camm A and Datta SN. Novel anticoagulants and antiplatelet agents; a guide for the urologist. BJU Int 2015; 116: 687–696.
Culkin DJ, Exaire EJ, Green D, et al. Anticoagulation and antiplatelet therapy in urological practice: ICUD/AUA review paper. J Urol 2014; 192: 1026–1034.
Mukerji G, Munasinghe I and Raza A. A survey of the peri operative management of urological patients on clopidogrel. Ann R Coll Surg Engl 2009; 91: 313–320.
Oprea AD, Noto CJ and Halaszynski TM. Risk stratifica tion, perioperative and periprocedural management of the patient receiving anticoagulant therapy. J Clin Anesth 2016; 34: 586–599.
Douketis JD, Spyropoulos AC, Kaatz S, et al. Perioperative bridging anticoagulation in patients with atrial fbrillation. N Engl J Med. 2015;373:823–33. https://doi.org/10.1056/NEJMo a1501035 The BRIDGE study is an important RCT showing that preoperative bridging in low-risk AF patients did not reduce the risk of thromboembolic events but increased perioperative bleeding risk.
Kovacs MJ, Wells PS, Anderson DR, et al. Postoperative low molecular weight heparin bridging treatment for patients at high risk of arterial thromboembolism (PERIOP2): Double blind randomised controlled trial. BMJ. 2021;373:n1205. https://doi.org/ 10.1136/bmj.n1205 The PERIOP2 study is an important RCT showing that postoperative bridging idid not reduce the risk of thromboembolic events.
Referanslar
Ellis G, John Camm A and Datta SN. Novel anticoagulants and antiplatelet agents; a guide for the urologist. BJU Int 2015; 116: 687–696.
Culkin DJ, Exaire EJ, Green D, et al. Anticoagulation and antiplatelet therapy in urological practice: ICUD/AUA review paper. J Urol 2014; 192: 1026–1034.
Mukerji G, Munasinghe I and Raza A. A survey of the peri operative management of urological patients on clopidogrel. Ann R Coll Surg Engl 2009; 91: 313–320.
Oprea AD, Noto CJ and Halaszynski TM. Risk stratifica tion, perioperative and periprocedural management of the patient receiving anticoagulant therapy. J Clin Anesth 2016; 34: 586–599.
Douketis JD, Spyropoulos AC, Kaatz S, et al. Perioperative bridging anticoagulation in patients with atrial fbrillation. N Engl J Med. 2015;373:823–33. https://doi.org/10.1056/NEJMo a1501035 The BRIDGE study is an important RCT showing that preoperative bridging in low-risk AF patients did not reduce the risk of thromboembolic events but increased perioperative bleeding risk.
Kovacs MJ, Wells PS, Anderson DR, et al. Postoperative low molecular weight heparin bridging treatment for patients at high risk of arterial thromboembolism (PERIOP2): Double blind randomised controlled trial. BMJ. 2021;373:n1205. https://doi.org/ 10.1136/bmj.n1205 The PERIOP2 study is an important RCT showing that postoperative bridging idid not reduce the risk of thromboembolic events.
