ПЛАНОВЫЕ НЕКАРДИАЛЬНЫЕ ХИРУРГИЧЕСКИЕ ВМЕШАТЕЛЬСТВА И АНТИТРОМБОТИЧЕСКАЯ ТЕРАПИЯ
И. С. Пряхин
ФГБУ ДПО «Центральная государственная медицинская академия» УД Президента РФ, Москва
С. С. Мурашко
ФГБУ ДПО «Центральная государственная медицинская академия» УД Президента РФ, Москва
И. Н. Пасечник
ФГБУ ДПО «Центральная государственная медицинская академия» УД Президента РФ, Москва
С. А. Бернс
ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России, Москва

Ключевые слова

ннекардиальная хирургия
антикоагулянты
дезагреганты
кровотечение
тромбоз

Как цитировать

[1]
И. С. Пряхин, С. С. Мурашко, И. Н. Пасечник, и С. А. Бернс, ПЛАНОВЫЕ НЕКАРДИАЛЬНЫЕ ХИРУРГИЧЕСКИЕ ВМЕШАТЕЛЬСТВА И АНТИТРОМБОТИЧЕСКАЯ ТЕРАПИЯ, КМКВ, т. 4, сс. 83-90, янв. 2021.

Аннотация

В последние годы увеличилось количество пациентов, длительно получающих антитромботические препараты для предотвращения ишемических и тромбоэмболических сердечно-сосудистых событий. Выполнение плановых оперативных вмешательств у таких больных сопряжено с риском возникновения как геморрагических, так и тромбоэмболических осложнений. Клиницисту необходимо учитывать множество факторов, влияющих на систему гемостаза: базовую терапию, назначенную пациенту, оперативное вмешательство, препараты для анестезии, иммобилизацию больного и др. В настоящей статье с позиций мультидисциплинарного подхода рассматриваются вопросы курации коморбидных больных, которым выполнены плановые хирургические операции.

Литература

1. World Health Organization et al. World health statistics 2019: monitoring health for the SDGs, sustainable development goals. – 2019. URL: https://apps.who.int/iris/bitstream/handle/10665/324835/9789241565707-eng.pdf.
2. Сердечно-сосудистые заболевания. Всемирная организация здравоохранения. 2017 г. [Cardiovascular diseases. World health organization. In Russian]. URL: https://www.who.int/ru/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds).
3. Aitken M., Kleinrock M. Global medicines use in 2020: outlook and implications //USA: Parsippany, New Jersey. – 2015. URL: https://www.iqvia.com/-/media/iqvia/pdfs/institute-reports/global-medicines-use-in-2020
4. Knuuti J. et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC) //European Heart Journal. – 2020. – V. 41. – №. 3. – P. 407-477. doi: 10.1093/eurheartj/ehz425.
5. Valgimigli M. et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS //European journal of cardio-thoracic surgery. – 2018. – V. 53. – №. 1. – P.34-78. doi: 10.1093/eurheartj/ehx419.
6. Population Division. Department of Economic and Social Affairs. United Nations. Revision of World Population Prospects. URL: https://esa.un.org/unpd/wpp/ . – 2017.
7. Aboyans V et al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). //European heart journal. – 2018. – V. 39. – №. 9. – P. 763-816. https://doi.org/10.1093/eurheartj/ehx095.
8. Alonso A et al. A rising tide: the global epidemic of atrial fibrillation. //Circulation. – 2014. – V. 129. – №. 8. – P. 829–830. https://doi.org/10.1161/CIRCULATIONAHA.113.007482.
9. Camm A. J. et al. 2012 focused update of the ESC guidelines for the management of atrial fibrillation: an update of the 2010 ESC guidelines for the management of atrial fibrillation developed with the special contribution of the European Heart Rhythm Association //European heart journal. – 2012. – V. 33. – №. 21. – P. 2719-2747.doi: 10.1093/eurheartj/ehs253.
10. Ge Y. et al. Association of atrial fibrillation and oral anticoagulant use with perioperative outcomes after major noncardiac surgery //Journal of the American Heart Association. – 2017. – V. 6. – №. 12. – P.e006022. doi: 10.1161 / JAHA.117.006022.
11. Kirchhof Р B. S. et al. ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS //European heart journal. – 2016. – V. 37. – №. 7. – P. 2893-2962. https://doi.org/10.1093/eurheartj/ehw210.
12. Baumgartner H. et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease //European heart journal. – 2017. – V. 38. – №. 36. – P. 2739-2791.doi: 10.1093/eurheartj/ehx391.
13. Konstantinides S. V. et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS) The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC) //European heart journal. – 2020. – V. 41. – №. 4. – P. 543-603. https://doi.org/10.1093/eurheartj/ehz405.
14. Заболотских И. Б. и др. Периоперационное ведение пациентов, получающих длительную антитромботическую терапию. Клинические рекомендации Федерации анестезиологов и реаниматологов //Вестник интенсивной терапии имени АИ Салтанова. – 2019. – №. 1. – P. 7-19. [Zabolotskih I. B. et al. Perioperative management of patients receiving long-term antithrombotic therapy. Clinical guidelines. //Vestnik intensivnoi terapii imeni A.I. Saltanova (Аnnals of critical care named after A.I. Saltanov). – 2019. – №. 1. – P. 7-19. In Russian] DOI: 10.21320/1818-474X-2019-1-7-19.
15. Keeling D. et al. Peri‐operative management of anticoagulation and antiplatelet therapy //British journal of haematology. – 2016. – V. 175. – №. 4. – P. 602-613.https://doi.org/10.1111/bjh.14344.
16. Андрияшкин А. В. и др. Российские клинические рекомендации по диагностике, лечению и профилактике венозных тромбоэмболических осложнений (ВТЭО) //Флебология. – 2015. – V. 2. – №. 4. – P. 1-52 [Andriyashkin A. V. et al. Russian clinical guidelines for the diagnosis, treatment and prevention of venous thromboembolic complications (VTEC) // Phlebology. – 2015. – V.4. – № 2. – P. 1-52. In Russian.]
17. Haynes A. B. et al. A surgical safety checklist to reduce morbidity and mortality in a global population //New England Journal of Medicine. – 2009. – V. 360. – №. 5. – P. 491-499. DOI: 10.1056/NEJMsa0810119.
18. Smilowitz N. R. et al. Perioperative acute myocardial infarction associated with non-cardiac surgery //European heart journal. – 2017. – V. 38. – №. 31. – P. 2409-2417. doi: 10.1093/eurheartj/ehx313.
19. Berger P. B. et al. Frequency of major noncardiac surgery and subsequent adverse events in the year after drug-eluting stent placement: results from the EVENT (Evaluation of Drug-Eluting Stents and Ischemic Events) Registry //JACC: Cardiovascular Interventions. – 2010. – V.3. – №. 9. – P.920-927. doi: 10.1016/j.jcin.2010.03.021.
20. Smilowitz N. R., Lorin J., Berger J. S. Risks of noncardiac surgery early after percutaneous coronary intervention //American Heart Journal. – 2019. – V. 217. – P. 64-71. doi: 10.1016/j.ahj.2019.07.010.
21. Egholm G. et al. Risk associated with surgery within 12 months after coronary drug-eluting stent implantation //Journal of the American College of Cardiology. – 2016. – V. 68. – №. 24. – P. 2622-2632.doi: 10.1016/j.jacc.2016.09.967.
22. Helwani M. A. et al. Etiology of acute coronary syndrome after noncardiac surgery //Anesthesiology: The Journal of the American Society of Anesthesiologists. – 2018. – V. 128. – №. 6. – P. 1084-1091. doi: 10.1097/ALN.0000000000002107.
23. Smith B. B. et al. Cardiac risk of noncardiac surgery after percutaneous coronary intervention with second-generation drug-eluting stents //Anesthesia & Analgesia. – 2019. – V. 128. – №. 4. – P. 621-628. doi: 10.1213/ANE.0000000000003408.
24. Mahmoud K. D. et al. Perioperative cardiovascular risk of prior coronary stent implantation among patients undergoing noncardiac surgery //Journal of the American College of Cardiology. – 2016. – V. 67. – №. 9. – P. 1038-1049. doi: 10.1016/j.jacc.2015.11.063.
25. Anwaruddin S. et al. Characterization of post-operative risk associated with prior drug-eluting stent use //JACC: Cardiovascular Interventions. – 2009. – V. 2. – №. 6. – P. 542-549. doi: 10.1016/j.jcin.2009.03.014.
26. Schouten O. et al. Noncardiac surgery after coronary stenting: early surgery and interruption of antiplatelet therapy are associated with an increase in major adverse cardiac events //Journal of the American College of Cardiology. – 2007. – V. 49. – №. 1. – P. 122-124. DOI:10.1016/j.jacc.2006.10.004.
27. Devereaux P. J. et al. Aspirin in patients undergoing noncardiac surgery //N Engl J Med. – 2014. – V. 370. – С. 1494-1503. DOI: 10.1056 / NEJMoa1401105
28. Park S. K. et al. Risk of non-cardiac surgery after percutaneous coronary intervention with drug-eluting stents //Scientific reports. – 2017. – V. 7. – №. 1. – P. 1-9. doi: 10.1038/s41598-017-16672-z.
29. Graham M. M. et al. Aspirin in patients with previous percutaneous coronary intervention undergoing noncardiac surgery //Annals of internal medicine. – 2018. – V. 168. – №. 4. – P. 237-244. doi: 10.7326/M17-2341.
30. Oscarsson A. et al. To continue or discontinue aspirin in the perioperative period: a randomized, controlled clinical trial //British journal of anaesthesia. – 2010. – V. 104. – №. 3. – P. 305-312. doi: 10.1093/bja/aeq003.
31. Mantz J. 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 //British journal of anaesthesia. – 2011. – V. 107. – №. 6. – P. 899-910.doi: 10.1093/bja/aer274
32. Howell S. J. et al. Prospective observational cohort study of the association between antiplatelet therapy, bleeding and thrombosis in patients with coronary stents undergoing noncardiac surgery //British journal of anaesthesia. – 2019. – V. 122. – №. 2. – P. 170-179. doi: 10.1016/j.bja.2018.09.029.
33. Columbo J. A. et al. A meta-analysis of the impact of aspirin, clopidogrel, and dual antiplatelet therapy on bleeding complications in noncardiac surgery //Annals of surgery. – 2018. – V. 267. – №. 1. – P. 1-10. doi: 10.1097/SLA.0000000000002279.
34. Dargham B. B. et al. Intravenous antiplatelet therapy bridging in patients undergoing cardiac or non-cardiac surgery following percutaneous coronary intervention //Cardiovascular Revascularization Medicine. – 2019. – V. 20. – №. 9. – P. 805-811. doi: 10.1016/j.carrev.2018.11.018.
35. Siegal D. et al. Periprocedural heparin bridging in patients receiving vitamin K antagonists: systematic review and meta-analysis of bleeding and thromboembolic rates //Circulation. – 2012. – V. 126. – №. 13. – С. 1630-1639. DOI:10.1161/CIRCULATIONAHA.112.105221.
36. Douketis J. D. et al. Perioperative bridging anticoagulation in patients with atrial fibrillation //New England Journal of Medicine. – 2015. – V. 373. – №. 9. – P. 823-833. doi: 10.1056/NEJMoa1501035.
37. Dunn A. S., Spyropoulos A. C., Turpie A. G. G. Bridging therapy in patients on long‐term oral anticoagulants who require surgery: the Prospective Peri‐operative Enoxaparin Cohort Trial (PROSPECT) //Journal of Thrombosis and Haemostasis. – 2007. – V. 5. – №. 11. – P. 2211-2218. https://doi.org/10.1111/j.1538-7836.2007.02729.x
38. Shaw J. R. et al. Perioperative interruption of direct oral anticoagulants in patients with atrial fibrillation: a systematic review and meta‐analysis //Research and practice in thrombosis and haemostasis. – 2018. – V. 2. – №. 2. – P. 282-290. doi: 10.1002/rth2.12076.
39. Yong J. W. et al. Periprocedural heparin bridging in patients receiving oral anticoagulation: a systematic review and meta-analysis //BMC cardiovascular disorders. – 2017. – V. 17. – №. 1. – P. 1-12. doi: 10.1186/s12872-017-0719-7.
40. Ayoub K. et al. Perioperative heparin bridging in atrial fibrillation patients requiring temporary interruption of anticoagulation: evidence from meta-analysis //Journal of Stroke and Cerebrovascular Diseases. – 2016. – V. 25. – №. 9. – P. 2215-2221. doi: 10.1016/j.jstrokecerebrovasdis.2016.04.006.
41. Gotoh S. et al. Management of Antithrombotic Agents During Surgery or Other Kinds of Medical Procedures With Bleeding: The MARK Study //Journal of the American Heart Association. – 2020. – V. 9. – №. 5. – e012774. doi: 10.1161/JAHA.119.012774.
42. Malato A. et al. Patients requiring interruption of long‐term oral anticoagulant therapy: the use of fixed sub‐therapeutic doses of low‐molecular‐weight heparin //Journal of Thrombosis and Haemostasis. – 2010. – V. 8. – №. 1. – P. 107-113. doi: 10.1111/j.1538-7836.2009.03649.x. Epub 2009 Oct 11.
43. Douketis J. D. et al. Perioperative management of patients with atrial fibrillation receiving a direct oral anticoagulant //JAMA internal medicine. – 2019. – V. 179. – №. 11. – P. 1469-1478. doi: 10.1001/jamainternmed.2019.2431.
44. He H. et al. Novel oral anticoagulants in the preoperative period: a meta-analysis //Journal of thrombosis and thrombolysis. – 2018. – V. 45. – №. 3. – P. 386-396. doi: 10.1007/s11239-018-1612-7.
45. Shaw J. et al. Thrombotic and bleeding outcomes following perioperative interruption of direct oral anticoagulants in patients with venous thromboembolic disease //Journal of Thrombosis and Haemostasis. – 2017. – V. 15. – №. 5. – P. 925-930. doi: 10.1111/jth.13670.
46. Shaw J. R. et al. Periprocedural interruption of anticoagulation in patients with cancer‐associated venous thromboembolism: An analysis of thrombotic and bleeding outcomes //Journal of Thrombosis and Haemostasis. – 2019. – V. 17. – №. 7. – P. 1171-1178. doi: 10.1111/jth.14468.
47. Valle J. A. et al. Triple Antithrombotic Therapy and Outcomes in Post-PCI Patients Undergoing Non-cardiac Surgery //World journal of surgery. – 2017. – P. 41. – №. 2. – С. 423-432. doi: 10.1007/s00268-016-3725-5.
48. Llau J. V. et al. Anticlotting drugs and regional anaesthetic and analgesic techniques: comparative update of the safety recommendations //European journal of anaesthesiology. – 2007. – V.24. – №.5. – P.387-398. doi: 10.1017/S0265021506001918.
49. Gogarten W. et al. Regional anaesthesia and antithrombotic agents: recommendations of the European Society of Anaesthesiology. //European journal of anaesthesiology. – 2010. – V.27. – №.12. – P.999-1015. doi:10.1097/EJA.0b013e32833f6f6f
50. Hardy M. et al. Reduction of Preoperative Waiting Time Before Urgent Surgery for Patients on P2Y12 Inhibitors Using Multiple Electrode Aggregometry: A Retrospective Study //Journal of Clinical Medicine. – 2020. – V. 9. – №. 2. – P. 424. doi: 10.3390/jcm9020424.
51. Mahla E. et al. Platelet Inhibition and Bleeding in Patients Undergoing Non-Cardiac Surgery—The BIANCA Observational Study //Thrombosis and haemostasis. – 2018. – V. 118. – №. 05. – P. 864-872. doi: 10.1055/s-0038-1641153.
52. Mahla E. et al. Platelet Function Measurement–Based Strategy to Reduce Bleeding and Waiting Time in Clopidogrel-Treated Patients Undergoing Coronary Artery Bypass Graft Surgery: The Timing Based on Platelet Function Strategy to Reduce Clopidogrel-Associated Bleeding Related to CABG (TARGET-CABG) Study //Circulation: Cardiovascular Interventions. – 2012. – V. 5. – №. 2. – P. 261-269. doi: 10.1161/CIRCINTERVENTIONS.111.967208.
53. Kasivisvanathan R. et al. Risk of bleeding and adverse outcomes predicted by thromboelastography platelet mapping in patients taking clopidogrel within 7 days of non‐cardiac surgery //British Journal of Surgery. – 2014. – V. 101. – №. 11. – P. 1383-1390. doi: 10.1002/bjs.9592.
54. Corredor C. et al. The role of point‐of‐care platelet function testing in predicting postoperative bleeding following cardiac surgery: a systematic review and meta‐analysis //Anaesthesia. – 2015. – V. 70. – №. 6. – P. 715-731. doi: 10.1111/anae.13083.
55. Баландина А. Н. и др. Тромбодинамика: новый подход к диагностике нарушений системы гемостаза //Вопросы гематологии/онкологии и иммунопатологии в педиатрии. – 2019. – V. 17. – №. 4. – P. 114-126. [Balandina A.N. et al. Thrombodynamics: a new approach to the diagnostics of hemostasis disorders. //Voprosy gematologii/onkologii i immunopatologii v pediatrii (Pediatric Hematology/Oncology and Immunopathology). – 2018. – V.17 – № 4. – P. 114‒126. In Russian]. doi: 10.24287/1726-1708-2018-17-4-114-126.