圍術(shù)期抗凝藥與應(yīng)對(duì)策略doc(參考版)
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【正文】 361(9353):201205.9 / 9。93(2):275287.16. Iselin BM, Willimann PF, Seifert B, et al. Isolated reduction of haematocrit does not promise in vitro blood coagulation. Br J Anaesth, 2001。355(9212): 12891290.14. Molenaar IQ, Porte RJ. Aprotinin and thromboembolism in liver transplantation: is there really a causal effect? Anesth Analg, 2002。163(8):901908.12. Shpitz B, Plotkin E, Spindel Z, et al. Should aspirin therapy be withheld before insertion and/or removal of a permanent peritoneal dialysis catheter? Am Surg, 2002。119(1 Suppl):8S21S.10. Harder S, Klinkhardt U, Alvarez JM. Avoidance of bleeding during surgery in patients receiving anticoagulant and/or antiplatelet therapy: pharmacokinetic and pharmacodynamic considerations. Clin Pharmacokinet, 2004。51(3):280282.8. Jafri SM. Periprocedural thromboprophylaxis in patients receiving chronic anticoagulation therapy. Am Heart J, 2004。63(11):11211163.6. Kearon C, Hirsh J. Management of anticoagulation before and after surgery. N Engl J Med, 1997。140(3):175183.4. Eikelboom JW, Anand SS, Malmberg K, et al. Unfractionated heparin and lowmolecularweight heparin in acute coronary syndrome without ST elevation: a metaanalysis. Lancet, 2000。參考文獻(xiàn)1. 胡大一. 心血管疾病的溶栓、抗栓治療. 見(jiàn)葉任高 陸再英 主編內(nèi)科學(xué)，人民衛(wèi)生出版社，2004年第6版：358362.2. Hirsh J, Fuster V, Ansell J, et al. American Heart Association/American College of Cardiology Foundation guide to warfarin therapy. Circulation, 2003。3 結(jié)語(yǔ)越來(lái)越多的病人在圍術(shù)期可能會(huì)接受抗凝和/或抗血小板治療，同時(shí)，一些新的、不可拮抗的抗凝/抗血小板藥物在臨床的應(yīng)用，這給外科手術(shù)及圍術(shù)期管理帶來(lái)了新的挑戰(zhàn)。rFⅦa已經(jīng)成功地應(yīng)用于華法林所致的出血、血小板數(shù)量及功能異常以及一些外科手術(shù)的嚴(yán)重出血，能夠顯著減少出血，降低大手術(shù)術(shù)中輸血的可能。其結(jié)果是導(dǎo)致了局部凝血酶爆發(fā)，這不僅反饋激活內(nèi)源性凝血途徑諸因子而且激活了更多的血小板，從而最終導(dǎo)致了纖維蛋白的產(chǎn)生。 重組激活因子Ⅶa重組激活因子Ⅶa（rFⅦa）是一種新型的促凝劑，是目前唯一的不僅可以替代某一凝血因子缺失的治療，而且能啟動(dòng)并促進(jìn)整個(gè)凝血過(guò)程的止血藥物。曾經(jīng)有文獻(xiàn)
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