Çoklu Antikoagülan ve Antiagregan Kullanan Koroner Stentli Hastalarda Ürolojik Operasyonların Genel Yönetimi
Özet
Öncelikli olarak hastaların Preoperatif Kardiyak risklerinin değerlendirilmesi gerekir.Cerrahiye bağlı risklerin etkin değerlendirilmesi ve operasyonun kanama riskinin belirlenmesi önemlidir.DAPT alan hastalarda Stent Trombozu açısından yüksek riskli hastalar özenle ayırt edilmelidir. YOAK tedavisinde köprüleme yoktur, gerekirse Postop proflaktik Heparin önerilir. Antikoagülan kullanan hastalarda Yüksek Trombotik Risk’e sahip hastalara dikkat edilmelidir.Mekanik Kalp Kapağı olanlarda(AVR,MVR,TVR gibi) Yüksek Tromboemboli riski var ise Köprüleme yapılmalıdır.
First and foremost, the preoperative cardiac risks of patients should be assessed. An effective evaluation of the risks associated with surgery and the determination of the risk of bleeding during the operation are essential. Patients receiving DAPT should be carefully distinguished as those at high risk for stent thrombosis. In the management of YOAK, bridging is not performed; if necessary, postoperative prophylactic Heparin is recommended. Patients using anticoagulants must be identified as those with high thrombotic risk. In patients with mechanical heart valves (such as AVR, MVR, TVR), if there is a high risk of thromboembolism, bridging should be performed.
Referanslar
Glance LG, Lustik SJ, Hannan EL, Osler TM, Mukamel DB, Qian F, et al. The Surgical Mortality Probability Model: derivation and validation of a simple risk prediction rule for noncardiac surgery. Ann Surg 2012;255:696–702.
Muller MD, Lyrer P, Brown MM, Bonati LH. Carotid artery stenting versus endarterectomy for treatment of carotid artery stenosis. Cochrane Database Syst Rev 2020;2:CD000515.
Bendixen M, Jørgensen OD, Kronborg C, Andersen C, Licht PB. Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer: a randomised controlled trial. Lancet Oncol 2016;17:836–844.
Falcoz PE, Puyraveau M, Thomas PA, Decaluwe H, Hürtgen M, Petersen RH, et al. Video-assisted thoracoscopic surgery versus open lobectomy for primary non-small-cell lung cancer: a propensity-matched analysis of outcome from the European Society of Thoracic Surgeon database. Eur J Cardiothorac Surg 2016;49: 602–609
. Martin D, Mantziari S, Demartines N, Hubner M, Study Group ESA. Defining major surgery: a Delphi consensus among European Surgical Association (ESA) members. World J Surg 2020;44:2211–2219.
Bolliger M, Kroehnert JA, Molineus F, Kandioler D, Schindl M, Riss P. Experiences with the standardized classification of surgical complications (Clavien-Dindo) in general surgery patients. Eur Surg 2018;50:256–261.
Nguyen NT, Wolfe BM. The physiologic effects of pneumoperitoneum in the morbidly obese. Ann Surg 2005;241:219–226
. Jeger RV, Probst C, Arsenic R, Lippuner T, Pfisterer ME, Seeberger MD, et al. Long-term prognostic value of the preoperative 12-lead electrocardiogram before major noncardiac surgery in coronary artery disease. Am Heart J 2006;151:508–513.
Mueller D, Puelacher C, Honegger U, Walter JE, Badertscher P, Schaerli N, et al. Direct comparison of cardiac troponin T and I using a uniform and a sex-specific approach in the detection of functionally relevant coronary artery disease. Clin Chem 2018;64:1596–1606.
Weber M, Luchner A, Seeberger M, Mueller C, Liebetrau C, Schlitt A, et al. Incremental value of high-sensitive troponin T in addition to the revised cardiac index for peri-operative risk stratification in non-cardiac surgery. Eur Heart J 2013;34: 853–862
Walter JE, Honegger U, Puelacher C, Mueller D, Wagener M, Schaerli N, et al. Prospective validation of a biomarker-based rule out strategy for functionally relevant coronary artery disease. Clin Chem 2018;64:386–395.
Writing Committee for the Vision Study Investigators, Devereaux PJ, Biccard BM, Sigamani A, Xavier D, Chan MTV, et al. Association of postoperative high-sensitivity troponin levels with myocardial injury and 30-day mortality among patients undergoing noncardiac surgery. JAMA 2017;317:1642–1651
Steeds RP, Garbi M, Cardim N, Kasprzak JD, Sade E, Nihoyannopoulos P, et al. EACVI appropriateness criteria for the use of transthoracic echocardiography in adults: a report of literature and current practice review. Eur Heart J Cardiovasc Imaging 2017;18:1191–1204.
Wijeysundera DN, Beattie WS, Karkouti K, Neuman MD, Austin PC, Laupacis A. Association of echocardiography before major elective non-cardiac surgery with postoperative survival and length of hospital stay: population based cohort study. BMJ 2011;342:d3695
Boersma E, Poldermans D, Bax JJ, Steyerberg EW, Thomson IR, Banga JD, et al. Predictors of cardiac events after major vascular surgery: role of clinical characteristics, dobutamine echocardiography, and beta-blocker therapy. JAMA 2001;285: 1865–1873
Collet JP, Thiele H, Barbato E, Barthelemy O, Bauersachs J, Bhatt DL, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2021;42:1289–1367.
Steffel J, Collins R, Antz M, Cornu P, Desteghe L, Haeusler KG, et al. 2021 European Heart Rhythm Association Practical Guide on the use of non-vitamin k antagonist oral anticoagulants in patients with atrial fibrillation. Europace 2021;23:1612–1676
Gurbel PA, Bliden KP, Butler K, Tantry US, Gesheff T, Wei C, et al. Randomized double-blind assessment of the ONSET and OFFSET of the antiplatelet effects of ticagrelor versus clopidogrel in patients with stable coronary artery disease: the ONSET/OFFSET study. Circulation 2009;120:2577–2585.
Kim BK, Hong MK, Shin DH, Nam CM, Kim JS, Ko YG, et al. A new strategy for discontinuation of dual antiplatelet therapy: the RESET Trial (REal Safety and Efficacy of 3-month dual antiplatelet Therapy following Endeavor zotarolimus-eluting stent implantation). J Am Coll Cardiol 2012;60:1340–1348.
. Schulz-Schupke S, Byrne RA, Ten Berg JM, Neumann FJ, Han Y, Adriaenssens T, et al. ISAR-SAFE: a randomized, double-blind, placebo-controlled trial of 6 vs. 12 months of clopidogrel therapy after drug-eluting stenting. Eur Heart J 2015;36: 1252–1263.
Watanabe H, Domei T, Morimoto T, Natsuaki M, Shiomi H, Toyota T, et al. Effect of 1-month dual antiplatelet therapy followed by clopidogrel vs 12-month dual antiplatelet therapy on cardiovascular and bleeding events in patients receiving PCI: the STOPDAPT-2 randomized clinical trial. JAMA 2019;321:2414–2427.
Valgimigli M, Frigoli E, Heg D, Tijssen J, Juni P, Vranckx P, et al. Dual antiplatelet therapy after PCI in patients at high bleeding risk. N Engl J Med 2021;385:1643–1655.
Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 2019;40: 87–165.
Windecker S, Lopes RD, Massaro T, Jones-Burton C, Granger CB, Aronson R, et al. Antithrombotic therapy in patients with atrial fibrillation and acute coronary syndrome treated medically or with percutaneous coronary intervention or undergoing elective percutaneous coronary intervention: insights from the AUGUSTUS trial. Circulation 2019;140:1921–1932.
Devereaux PJ, Mrkobrada M, Sessler DI, Leslie K, Alonso-Coello P, Kurz A, et al. Aspirin in patients undergoing noncardiac surgery. N Engl J Med 2014;370: 1494–1503.
Godier A, Dincq AS, Martin AC, Radu A, Leblanc I, Antona M, et al. Predictors of pre-procedural concentrations of direct oral anticoagulants: a prospective multicentre study. Eur Heart J 2017;38:2431–2439.
Pollack CV, Jr., Reilly PA, van Ryn J, Eikelboom JW, Glund S, Bernstein RA, et al. Idarucizumab for dabigatran reversal - full cohort analysis. N Engl J Med 2017; 377:431–441.
Albaladejo P, Pernod G, Godier A, de Maistre E, Rosencher N, Mas JL, et al. Management of bleeding and emergency invasive procedures in patients on dabigatran: updated guidelines from the French Working Group on Perioperative Haemostasis (GIHP) – September 2016. Anaesth Crit Care Pain Med 2018;37: 391–399.
Referanslar
Glance LG, Lustik SJ, Hannan EL, Osler TM, Mukamel DB, Qian F, et al. The Surgical Mortality Probability Model: derivation and validation of a simple risk prediction rule for noncardiac surgery. Ann Surg 2012;255:696–702.
Muller MD, Lyrer P, Brown MM, Bonati LH. Carotid artery stenting versus endarterectomy for treatment of carotid artery stenosis. Cochrane Database Syst Rev 2020;2:CD000515.
Bendixen M, Jørgensen OD, Kronborg C, Andersen C, Licht PB. Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer: a randomised controlled trial. Lancet Oncol 2016;17:836–844.
Falcoz PE, Puyraveau M, Thomas PA, Decaluwe H, Hürtgen M, Petersen RH, et al. Video-assisted thoracoscopic surgery versus open lobectomy for primary non-small-cell lung cancer: a propensity-matched analysis of outcome from the European Society of Thoracic Surgeon database. Eur J Cardiothorac Surg 2016;49: 602–609
. Martin D, Mantziari S, Demartines N, Hubner M, Study Group ESA. Defining major surgery: a Delphi consensus among European Surgical Association (ESA) members. World J Surg 2020;44:2211–2219.
Bolliger M, Kroehnert JA, Molineus F, Kandioler D, Schindl M, Riss P. Experiences with the standardized classification of surgical complications (Clavien-Dindo) in general surgery patients. Eur Surg 2018;50:256–261.
Nguyen NT, Wolfe BM. The physiologic effects of pneumoperitoneum in the morbidly obese. Ann Surg 2005;241:219–226
. Jeger RV, Probst C, Arsenic R, Lippuner T, Pfisterer ME, Seeberger MD, et al. Long-term prognostic value of the preoperative 12-lead electrocardiogram before major noncardiac surgery in coronary artery disease. Am Heart J 2006;151:508–513.
Mueller D, Puelacher C, Honegger U, Walter JE, Badertscher P, Schaerli N, et al. Direct comparison of cardiac troponin T and I using a uniform and a sex-specific approach in the detection of functionally relevant coronary artery disease. Clin Chem 2018;64:1596–1606.
Weber M, Luchner A, Seeberger M, Mueller C, Liebetrau C, Schlitt A, et al. Incremental value of high-sensitive troponin T in addition to the revised cardiac index for peri-operative risk stratification in non-cardiac surgery. Eur Heart J 2013;34: 853–862
Walter JE, Honegger U, Puelacher C, Mueller D, Wagener M, Schaerli N, et al. Prospective validation of a biomarker-based rule out strategy for functionally relevant coronary artery disease. Clin Chem 2018;64:386–395.
Writing Committee for the Vision Study Investigators, Devereaux PJ, Biccard BM, Sigamani A, Xavier D, Chan MTV, et al. Association of postoperative high-sensitivity troponin levels with myocardial injury and 30-day mortality among patients undergoing noncardiac surgery. JAMA 2017;317:1642–1651
Steeds RP, Garbi M, Cardim N, Kasprzak JD, Sade E, Nihoyannopoulos P, et al. EACVI appropriateness criteria for the use of transthoracic echocardiography in adults: a report of literature and current practice review. Eur Heart J Cardiovasc Imaging 2017;18:1191–1204.
Wijeysundera DN, Beattie WS, Karkouti K, Neuman MD, Austin PC, Laupacis A. Association of echocardiography before major elective non-cardiac surgery with postoperative survival and length of hospital stay: population based cohort study. BMJ 2011;342:d3695
Boersma E, Poldermans D, Bax JJ, Steyerberg EW, Thomson IR, Banga JD, et al. Predictors of cardiac events after major vascular surgery: role of clinical characteristics, dobutamine echocardiography, and beta-blocker therapy. JAMA 2001;285: 1865–1873
Collet JP, Thiele H, Barbato E, Barthelemy O, Bauersachs J, Bhatt DL, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2021;42:1289–1367.
Steffel J, Collins R, Antz M, Cornu P, Desteghe L, Haeusler KG, et al. 2021 European Heart Rhythm Association Practical Guide on the use of non-vitamin k antagonist oral anticoagulants in patients with atrial fibrillation. Europace 2021;23:1612–1676
Gurbel PA, Bliden KP, Butler K, Tantry US, Gesheff T, Wei C, et al. Randomized double-blind assessment of the ONSET and OFFSET of the antiplatelet effects of ticagrelor versus clopidogrel in patients with stable coronary artery disease: the ONSET/OFFSET study. Circulation 2009;120:2577–2585.
Kim BK, Hong MK, Shin DH, Nam CM, Kim JS, Ko YG, et al. A new strategy for discontinuation of dual antiplatelet therapy: the RESET Trial (REal Safety and Efficacy of 3-month dual antiplatelet Therapy following Endeavor zotarolimus-eluting stent implantation). J Am Coll Cardiol 2012;60:1340–1348.
. Schulz-Schupke S, Byrne RA, Ten Berg JM, Neumann FJ, Han Y, Adriaenssens T, et al. ISAR-SAFE: a randomized, double-blind, placebo-controlled trial of 6 vs. 12 months of clopidogrel therapy after drug-eluting stenting. Eur Heart J 2015;36: 1252–1263.
Watanabe H, Domei T, Morimoto T, Natsuaki M, Shiomi H, Toyota T, et al. Effect of 1-month dual antiplatelet therapy followed by clopidogrel vs 12-month dual antiplatelet therapy on cardiovascular and bleeding events in patients receiving PCI: the STOPDAPT-2 randomized clinical trial. JAMA 2019;321:2414–2427.
Valgimigli M, Frigoli E, Heg D, Tijssen J, Juni P, Vranckx P, et al. Dual antiplatelet therapy after PCI in patients at high bleeding risk. N Engl J Med 2021;385:1643–1655.
Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 2019;40: 87–165.
Windecker S, Lopes RD, Massaro T, Jones-Burton C, Granger CB, Aronson R, et al. Antithrombotic therapy in patients with atrial fibrillation and acute coronary syndrome treated medically or with percutaneous coronary intervention or undergoing elective percutaneous coronary intervention: insights from the AUGUSTUS trial. Circulation 2019;140:1921–1932.
Devereaux PJ, Mrkobrada M, Sessler DI, Leslie K, Alonso-Coello P, Kurz A, et al. Aspirin in patients undergoing noncardiac surgery. N Engl J Med 2014;370: 1494–1503.
Godier A, Dincq AS, Martin AC, Radu A, Leblanc I, Antona M, et al. Predictors of pre-procedural concentrations of direct oral anticoagulants: a prospective multicentre study. Eur Heart J 2017;38:2431–2439.
Pollack CV, Jr., Reilly PA, van Ryn J, Eikelboom JW, Glund S, Bernstein RA, et al. Idarucizumab for dabigatran reversal - full cohort analysis. N Engl J Med 2017; 377:431–441.
Albaladejo P, Pernod G, Godier A, de Maistre E, Rosencher N, Mas JL, et al. Management of bleeding and emergency invasive procedures in patients on dabigatran: updated guidelines from the French Working Group on Perioperative Haemostasis (GIHP) – September 2016. Anaesth Crit Care Pain Med 2018;37: 391–399.
