Практические аспекты антитромботической терапии у пациентов, нуждающихся в длительном приеме пероральных антикоагулянтов, при проведении хирургических вмешательств

У пациентов, нуждающихся в длительной антикоагулянтной профилактике тромбоэмболических осложнений, необходимость и длительность отмены пероральных антикоагулянтов при оперативном вмешательстве зависит от баланса риска кровотечения и тромбоза, а также от типа антикоагулянтов. В статье приводится классификация хирургических вмешательств по степени риска периоперационного кровотечения. При операциях с минимальным риском кровотечения отмены пероральных антикоагулянтов не требуется. При среднем и высоком риске кровотечения необходимо прерывание приема пероральных антикоагулянтов. Срок отмены прямых пероральных антикоагулянтов короче, чем при использовании варфарина. Потребность в бридж-терапии парентеральными антикоагулянтами зависит от риска тромбоза и длительности отмены пероральных антикоагулянтов. Выделены группы пациентов с очень высоким риском тромбоза. При низком и умеренном риске тромбоза и кратковременном прерывании приема пероральных антикоагулянтов бридж-терапия не требуется. При очень высоком риске тромбоза и/или длительном периоде отмены пероральных антикоагулянтов рекомендована бридж-терапия на период прерывания приема пероральных антикоагулянтов.

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