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PCIおよび非心臓手術患者の抗血小板管理のアルゴリズム

*:患者が現在DAPTを使用していると仮定する。
出典
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1: 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
Circulation. 2014 Dec 9;130(24):e278-333. doi: 10.1161/CIR.0000000000000106. Epub 2014 Aug 1.

非整形外科手術におけるVTEのリスク評価

参考文献:
  1. Sadeghi B, Romano PS, Maynard G, Strater AL, Hensley L, Cerese J, White RH. Mechanical and suboptimal pharmacologic prophylaxis and delayed mobilization but not morbid obesity are associated with venous thromboembolism after total kneearthroplasty: a case-control study. J Hosp Med. 2012 Nov-Dec;7(9):665-71. doi: 10.1002/jhm.1962. Epub 2012 Oct 5. PubMed PMID: 23042665.
  1. Ho KM, Tan JA. Stratified meta-analysis of intermittent pneumatic compression of the lower limbs to prevent venous thromboembolism in hospitalized patients. Circulation. 2013 Aug 27;128(9):1003-20. doi: 10.1161/CIRCULATIONAHA.113.002690. Epub 2013 Jul 12. PubMed PMID: 23852609.
出典
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1: 著者提供

経口抗凝固薬(DOAC)の周術期管理

CrCl:クレアチニンクリアランス
出典
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1: Perioperative Management of Antithrombotic Therapy: An American College of Chest Physicians Clinical Practice Guideline.
著者: James D Douketis, Alex C Spyropoulos, M Hassan Murad, Juan I Arcelus, William E Dager, Andrew S Dunn, Ramiz A Fargo, Jerrold H Levy, C Marc Samama, Sahrish H Shah, Matthew W Sherwood, Alfonso J Tafur, Liang V Tang, Lisa K Moores
雑誌名: Chest. 2022 Nov;162(5):e207-e243. doi: 10.1016/j.chest.2022.07.025. Epub 2022 Aug 11.
Abstract/Text: BACKGROUND: The American College of Chest Physicians Clinical Practice Guideline on the Perioperative Management of Antithrombotic Therapy addresses 43 Patients-Interventions-Comparators-Outcomes (PICO) questions related to the perioperative management of patients who are receiving long-term oral anticoagulant or antiplatelet therapy and require an elective surgery/procedure. This guideline is separated into four broad categories, encompassing the management of patients who are receiving: (1) a vitamin K antagonist (VKA), mainly warfarin; (2) if receiving a VKA, the use of perioperative heparin bridging, typically with a low-molecular-weight heparin; (3) a direct oral anticoagulant (DOAC); and (4) an antiplatelet drug.
METHODS: Strong or conditional practice recommendations are generated based on high, moderate, low, and very low certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology for clinical practice guidelines.
RESULTS: A multidisciplinary panel generated 44 guideline recommendations for the perioperative management of VKAs, heparin bridging, DOACs, and antiplatelet drugs, of which two are strong recommendations: (1) against the use of heparin bridging in patients with atrial fibrillation; and (2) continuation of VKA therapy in patients having a pacemaker or internal cardiac defibrillator implantation. There are separate recommendations on the perioperative management of patients who are undergoing minor procedures, comprising dental, dermatologic, ophthalmologic, pacemaker/internal cardiac defibrillator implantation, and GI (endoscopic) procedures.
CONCLUSIONS: Substantial new evidence has emerged since the 2012 iteration of these guidelines, especially to inform best practices for the perioperative management of patients who are receiving a VKA and may require heparin bridging, for the perioperative management of patients who are receiving a DOAC, and for patients who are receiving one or more antiplatelet drugs. Despite this new knowledge, uncertainty remains as to best practices for the majority of perioperative management questions.

Copyright © 2022 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
Chest. 2022 Nov;162(5):e207-e243. doi: 10.1016/j.chest.2022.07.025. Ep...

周術期の心血管リスク評価アルゴリズム

参考文献:
Ciesielski TM, De Fer TM: General Internal Medicine Consult, 3rd ed., Philadelphia, Wolters Kluwer Health, 2016, p10, FIGURE 1-1.
出典
img
1: 著者提供

PCIおよび非心臓手術患者の抗血小板管理のアルゴリズム

*:患者が現在DAPTを使用していると仮定する。
出典
imgimg
1: 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
Circulation. 2014 Dec 9;130(24):e278-333. doi: 10.1161/CIR.0000000000000106. Epub 2014 Aug 1.

非整形外科手術におけるVTEのリスク評価

参考文献:
  1. Sadeghi B, Romano PS, Maynard G, Strater AL, Hensley L, Cerese J, White RH. Mechanical and suboptimal pharmacologic prophylaxis and delayed mobilization but not morbid obesity are associated with venous thromboembolism after total kneearthroplasty: a case-control study. J Hosp Med. 2012 Nov-Dec;7(9):665-71. doi: 10.1002/jhm.1962. Epub 2012 Oct 5. PubMed PMID: 23042665.
  1. Ho KM, Tan JA. Stratified meta-analysis of intermittent pneumatic compression of the lower limbs to prevent venous thromboembolism in hospitalized patients. Circulation. 2013 Aug 27;128(9):1003-20. doi: 10.1161/CIRCULATIONAHA.113.002690. Epub 2013 Jul 12. PubMed PMID: 23852609.
出典
img
1: 著者提供