Antikoagülan ve Antiagregan İlaç Kullanan Üroloji Hastalarında Anestezi Yönetimi
Özet
Ürolojik cerrahi geçirecek hastaların anestezi yönetimi, özellikle antikoagülan ve antiagregan ilaç kullanımı sözkonusu olduğunda karmaşık ve dikkat gerektiren bir süreçtir. Bu ilaçları kullanan hastaların her yıl yaklaşık %10’u girişimsel işleme maruz kalmaktadır. Bu nedenle üroloji ameliyathanelerinde bu hasta grubu ile sık sık karşılaşılmaktadır. Bu hastaların perioperatif yönetiminde, hastanın geçmiş tıbbi öyküsünün ve kullanılan ilaçların farmakolojisinin tam olarak anlaşılması gerektiği gibi aynı zamanda ilaçların kesilmesi veya devam ettirilmesi kararında ise multidisipliner yaklaşım gerekir. Bu bölümde güncel antikoagülan ve antiagregan kullanan üroloji hastalarında anestezi yönetimi güncel literatür ve kılavuzlar ışığında tartışılacaktır.
The anesthesia management of patients undergoing urologic surgery is a complex and careful process, especially when anticoagulant and antiaggregant medication is used. Approximately 10% of patients using these medications undergo interventional procedures each year. Therefore, these patients are frequently encountered in urology operating rooms. In the perioperative management of these patients, the patient's past medical history and the pharmacology of the medications used must be fully understood, and a multidisciplinary approach is required in the decision to discontinue or continue the medications. In this section, the anesthesia management of urologic patients using current anticoagulants and antiaggregants will be discussed in light of current literature and guidelines.
Referanslar
Culkin DJ, Exaire EJ, Green D, Soloway MS, Gross AJ, Desai MR, et al. Anticoagulation and Antiplatelet Therapy in Urological Practice: ICUD/AUA Review Paper. J Urol. 2014 Oct;192(4):1026–34.
Glick L, Chandrasekar T, Hubosky SG, Teplitsky S, Shah M, Leong JY, et al. How I Do It: Anticoagulation management for common urologic procedures. Can J Urol. 2020;27(6):10480–7.
Koo CH, Ryu JH. Anesthetic considerations for urologic surgeries. Korean J Anesthesiol. 2020 Apr 1;73(2):92–102.
Tsoumani ME, Tselepis AD. Antiplatelet Agents and Anticoagulants: From Pharmacology to Clinical Practice. Curr Pharm Des. 2017 Apr 25;23(9):1279–93.
Akyol A. Antithrombotic usage indications in atrial fibrillation. Trak Univ Tip Fak Derg. 2010;27:1–6.
Verstraete M. Heparin and Thrombosis: A Seventy Year Long Story. Pathophysiol Haemost Thromb. 1990;20(Suppl. 1):4–11.
Hirsh J, Anand SS, Halperin JL, Fuster V. Mechanism of Action and Pharmacology of Unfractionated Heparin. Arterioscler Thromb Vasc Biol. 2001 Jul;21(7):1094–6.
Töbü M. ANTİKOGÜLAN TEDAVİ 5. İlk Basamak Kursu. İzmir; 2006.
Wolzt M, Weltermann A, Nieszpaur-Los M, Schneider B, Fassolt A, Lechner K, et al. Studies on the Neutralizing Effects of Protamine on Unfractionated and Low Molecular Weight Heparin (Fragmin®) at the Site of Activation of the Coagulation System in Man. Thromb Haemost. 1995 Jul 9;73(03):439–43.
Gerdan V. Akılcı ilaç kullanımı: Varfarin. Ege Tıp Derg. 2021 Jan 20;19–31.
Kandemir H. New oral anticoagulants. J Heal Sci Med. 2019 Jan 25;2(1):24–9.
Mekaj A, Mekaj Y, Duci S, Miftari E. New oral anticoagulants: their advantages and disadvantages compared with vitamin K antagonists in the prevention and treatment of patients with thromboembolic events. Ther Clin Risk Manag. 2015 Jun;967.
Rai R, Sprengeler P, Elrod K, Young W. Perspectives on Factor Xa Inhibition. Curr Med Chem. 2001 Feb 1;8(2):101–19.
Gulseth MP, Michaud J, Nutescu EA. Rivaroxaban: An oral direct inhibitor of factor Xa. Am J Heal Pharm. 2008 Aug 15;65(16):1520–9.
Mueck W, Stampfuss J, Kubitza D, Becka M. Clinical Pharmacokinetic and Pharmacodynamic Profile of Rivaroxaban. Clin Pharmacokinet. 2014 Jan 3;53(1):1–16.
Wong PC, Pinto DJP, Zhang D. Preclinical discovery of apixaban, a direct and orally bioavailable factor Xa inhibitor. J Thromb Thrombolysis. 2011 May 13;31(4):478–92.
Brekelmans M, Middeldorp S, Coppens M. Direct factor Xa inhibitor edoxaban: from bench to clinical practice. Expert Rev Hematol. 2015 Nov 2;8(6):707–25.
Blech S, Ebner T, Ludwig-Schwellinger E, Stangier J, Roth W. The Metabolism and Disposition of the Oral Direct Thrombin Inhibitor, Dabigatran, in Humans. Drug Metab Dispos. 2008 Feb;36(2):386–99.
Eberli D, Chassot PG, Sulser T, Samama CM, Mantz J, Delabays A, et al. Urological Surgery and Antiplatelet Drugs After Cardiac and Cerebrovascular Accidents. J Urol. 2010 Jun;183(6):2128–36.
Fitzpatrick F. Cyclooxygenase Enzymes: Regulation and Function. Curr Pharm Des. 2004 Feb 1;10(6):577–88.
Savi P, Herbert JM. Clopidogrel and Ticlopidine: P2Y 12 Adenosine Diphosphate-Receptor Antagonists for the Prevention of Atherothrombosis. Semin Thromb Hemost. 2005 Apr;31(02):174–83.
Robinson A, Das K, Koshy SK, Das P. Prasugrel: Newest Antiplatelet Agent and Its Emerging Role in Management of Acute Coronary Syndrome and Percutaneous Coronary Intervention. Future Cardiol [Internet]. 2009 May 18;5(3):237–46. Available from: https://www.tandfonline.com/doi/full/10.2217/fca.09.1
Husted S, Van Giezen JJJ. Ticagrelor: The First Reversibly Binding Oral P2Y 12 Receptor Antagonist. Cardiovasc Ther [Internet]. 2009 Dec 9;27(4):259–74. Available from: https://onlinelibrary.wiley.com/doi/10.1111/j.1755-5922.2009.00096.x
Storey RF, Sinha A. Cangrelor for the management and prevention of arterial thrombosis. Expert Rev Cardiovasc Ther [Internet]. 2016 Sep 1;14(9):991–9. Available from: https://www.tandfonline.com/doi/full/10.1080/14779072.2016.1207528
Nurden AT, Poujol C, Durrieu-Jais C, Nurden P. Platelet Glycoprotein IIb/IIIa Inhibitors. Arterioscler Thromb Vasc Biol [Internet]. 1999 Dec;19(12):2835–40. Available from: https://www.ahajournals.org/doi/10.1161/01.ATV.19.12.2835
Panigrahi AK, Liu LL. Patient blood management: coagulation. In: Miller’s anesthesia. 9th editio. Philadelphia: Elsevier; 2020.
Chun R, Orser BA, Madan M. Platelet Glycoprotein IIb/IIIa Inhibitors: Overview and Implications for the Anesthesiologist. Anesth Analg [Internet]. 2002 Oct;95(4):879–88. Available from: https://journals.lww.com/00000539-200210000-00017
Crowther MA, Douketis JD, Schnurr T, Steidl L, Mera V, Ultori C, et al. Oral Vitamin K Lowers the International Normalized Ratio More Rapidly Than Subcutaneous Vitamin K in the Treatment of Warfarin-Associated Coagulopathy. Ann Intern Med [Internet]. 2002 Aug 20;137(4):251. Available from: http://annals.org/article.aspx?doi=10.7326/0003-4819-137-4-200208200-00009
Referanslar
Culkin DJ, Exaire EJ, Green D, Soloway MS, Gross AJ, Desai MR, et al. Anticoagulation and Antiplatelet Therapy in Urological Practice: ICUD/AUA Review Paper. J Urol. 2014 Oct;192(4):1026–34.
Glick L, Chandrasekar T, Hubosky SG, Teplitsky S, Shah M, Leong JY, et al. How I Do It: Anticoagulation management for common urologic procedures. Can J Urol. 2020;27(6):10480–7.
Koo CH, Ryu JH. Anesthetic considerations for urologic surgeries. Korean J Anesthesiol. 2020 Apr 1;73(2):92–102.
Tsoumani ME, Tselepis AD. Antiplatelet Agents and Anticoagulants: From Pharmacology to Clinical Practice. Curr Pharm Des. 2017 Apr 25;23(9):1279–93.
Akyol A. Antithrombotic usage indications in atrial fibrillation. Trak Univ Tip Fak Derg. 2010;27:1–6.
Verstraete M. Heparin and Thrombosis: A Seventy Year Long Story. Pathophysiol Haemost Thromb. 1990;20(Suppl. 1):4–11.
Hirsh J, Anand SS, Halperin JL, Fuster V. Mechanism of Action and Pharmacology of Unfractionated Heparin. Arterioscler Thromb Vasc Biol. 2001 Jul;21(7):1094–6.
Töbü M. ANTİKOGÜLAN TEDAVİ 5. İlk Basamak Kursu. İzmir; 2006.
Wolzt M, Weltermann A, Nieszpaur-Los M, Schneider B, Fassolt A, Lechner K, et al. Studies on the Neutralizing Effects of Protamine on Unfractionated and Low Molecular Weight Heparin (Fragmin®) at the Site of Activation of the Coagulation System in Man. Thromb Haemost. 1995 Jul 9;73(03):439–43.
Gerdan V. Akılcı ilaç kullanımı: Varfarin. Ege Tıp Derg. 2021 Jan 20;19–31.
Kandemir H. New oral anticoagulants. J Heal Sci Med. 2019 Jan 25;2(1):24–9.
Mekaj A, Mekaj Y, Duci S, Miftari E. New oral anticoagulants: their advantages and disadvantages compared with vitamin K antagonists in the prevention and treatment of patients with thromboembolic events. Ther Clin Risk Manag. 2015 Jun;967.
Rai R, Sprengeler P, Elrod K, Young W. Perspectives on Factor Xa Inhibition. Curr Med Chem. 2001 Feb 1;8(2):101–19.
Gulseth MP, Michaud J, Nutescu EA. Rivaroxaban: An oral direct inhibitor of factor Xa. Am J Heal Pharm. 2008 Aug 15;65(16):1520–9.
Mueck W, Stampfuss J, Kubitza D, Becka M. Clinical Pharmacokinetic and Pharmacodynamic Profile of Rivaroxaban. Clin Pharmacokinet. 2014 Jan 3;53(1):1–16.
Wong PC, Pinto DJP, Zhang D. Preclinical discovery of apixaban, a direct and orally bioavailable factor Xa inhibitor. J Thromb Thrombolysis. 2011 May 13;31(4):478–92.
Brekelmans M, Middeldorp S, Coppens M. Direct factor Xa inhibitor edoxaban: from bench to clinical practice. Expert Rev Hematol. 2015 Nov 2;8(6):707–25.
Blech S, Ebner T, Ludwig-Schwellinger E, Stangier J, Roth W. The Metabolism and Disposition of the Oral Direct Thrombin Inhibitor, Dabigatran, in Humans. Drug Metab Dispos. 2008 Feb;36(2):386–99.
Eberli D, Chassot PG, Sulser T, Samama CM, Mantz J, Delabays A, et al. Urological Surgery and Antiplatelet Drugs After Cardiac and Cerebrovascular Accidents. J Urol. 2010 Jun;183(6):2128–36.
Fitzpatrick F. Cyclooxygenase Enzymes: Regulation and Function. Curr Pharm Des. 2004 Feb 1;10(6):577–88.
Savi P, Herbert JM. Clopidogrel and Ticlopidine: P2Y 12 Adenosine Diphosphate-Receptor Antagonists for the Prevention of Atherothrombosis. Semin Thromb Hemost. 2005 Apr;31(02):174–83.
Robinson A, Das K, Koshy SK, Das P. Prasugrel: Newest Antiplatelet Agent and Its Emerging Role in Management of Acute Coronary Syndrome and Percutaneous Coronary Intervention. Future Cardiol [Internet]. 2009 May 18;5(3):237–46. Available from: https://www.tandfonline.com/doi/full/10.2217/fca.09.1
Husted S, Van Giezen JJJ. Ticagrelor: The First Reversibly Binding Oral P2Y 12 Receptor Antagonist. Cardiovasc Ther [Internet]. 2009 Dec 9;27(4):259–74. Available from: https://onlinelibrary.wiley.com/doi/10.1111/j.1755-5922.2009.00096.x
Storey RF, Sinha A. Cangrelor for the management and prevention of arterial thrombosis. Expert Rev Cardiovasc Ther [Internet]. 2016 Sep 1;14(9):991–9. Available from: https://www.tandfonline.com/doi/full/10.1080/14779072.2016.1207528
Nurden AT, Poujol C, Durrieu-Jais C, Nurden P. Platelet Glycoprotein IIb/IIIa Inhibitors. Arterioscler Thromb Vasc Biol [Internet]. 1999 Dec;19(12):2835–40. Available from: https://www.ahajournals.org/doi/10.1161/01.ATV.19.12.2835
Panigrahi AK, Liu LL. Patient blood management: coagulation. In: Miller’s anesthesia. 9th editio. Philadelphia: Elsevier; 2020.
Chun R, Orser BA, Madan M. Platelet Glycoprotein IIb/IIIa Inhibitors: Overview and Implications for the Anesthesiologist. Anesth Analg [Internet]. 2002 Oct;95(4):879–88. Available from: https://journals.lww.com/00000539-200210000-00017
Crowther MA, Douketis JD, Schnurr T, Steidl L, Mera V, Ultori C, et al. Oral Vitamin K Lowers the International Normalized Ratio More Rapidly Than Subcutaneous Vitamin K in the Treatment of Warfarin-Associated Coagulopathy. Ann Intern Med [Internet]. 2002 Aug 20;137(4):251. Available from: http://annals.org/article.aspx?doi=10.7326/0003-4819-137-4-200208200-00009
