Management of antiplatelet therapy for non-elective invasive procedures or bleeding complications: Proposals from the French Working Group on Perioperative Haemostasis (GIHP) and the French Study Group on Thrombosis and Haemostasis (GFHT), in collaboration with the French Society of Anaesthesia and Intensive Care Medicine (SFAR)

被引：1

作者：

Godier, Anne ^{[1
,2
]}

Garrigue, Delphine ^{[3
,4
]}

Lasne, Dominique ^{[5
]}

Fontana, Pierre ^{[6
,7
]}

Bonhomme, Fanny ^{[8
]}

Collet, Jean-Philippe ^{[9
]}

de Maistre, Emmanuel ^{[10
]}

Ickx, Brigitte ^{[11
]}

Gruel, Yves ^{[12
]}

Mazighi, Mikael ^{[13
,14
]}

Nguyen, Philippe ^{[15
]}

Vincentelli, Andre ^{[16
,17
,18
]}

Albaladejo, Pierre ^{[19
]}

Lecompte, Thomas ^{[6
,7
]}

Belisle, S. ^{[20
]}

Blais, N. ^{[21
]}

Borel-Derlon, A. ^{[22
]}

Borg, J. Y. ^{[23
]}

Bosson, J-L ^{[24
]}

Cohen, A. ^{[25
]}

Faraoni, D. ^{[26
]}

Huet, D. Garrigue ^{[27
]}

Guay, J. ^{[20
]}

Hardy, J. F. ^{[20
]}

Huet, Y. ^{[25
]}

Laporte, S. ^{[28
]}

Levy, J. H. ^{[29
]}

Llau, J. ^{[30
]}

Le Gal, G. ^{[31
]}

Lessire, S. ^{[32
]}

Longrois, D. ^{[33
]}

Madi-Jebara, S. ^{[34
]}

Marret, E. ^{[33
]}

Mas, J. L. ^{[35
]}

Meyer, G. ^{[36
]}

Mismetti, P. ^{[37
]}

Morange, P. E. ^{[38
]}

Motte, S. ^{[39
]}

Mullier, F. ^{[40
]}

Nathan, N. ^{[41
]}

Ozier, Y. ^{[42
]}

Pernod, G. ^{[24
]}

Rosencher, N. ^{[33
]}

Roullet, S. ^{[43
]}

Roy, P. M. ^{[44
]}

Samama, C. M. ^{[33
]}

Schlumberger, S. ^{[45
]}

Schved, J. F. ^{[46
]}

Sie, R. ^{[47
]}

Steib, A. ^{[48
]}

机构：

[1] Fdn Adolphe de Rothschild, Dept Anesthesie Reanimat, 29 Rue Manin, F-75019 Paris, France

[2] Univ Paris 05, Fac Pharm, INSERM, UMRS 1140, 4 Ave Observ, F-75006 Paris, France

[3] CHU Lille, Pole Anesthesie Reanimat, 2 Ave Oscar Lambret, F-59037 Lille, France

[4] CHU Lille, Pole Urgence, 2 Ave Oscar Lambret, F-59037 Lille, France

[5] Hop Necker Enfants Malad, AP HP, Lab Cent Hematol, 149 Rue Sevres, F-75015 Paris, France

[6] Hop Univ Geneve, Dept Specialites Med, Serv Angiol & Hemostase, Geneva, Switzerland

[7] Univ Geneva, Fac Med, Geneva Platelet Grp, Geneva, Switzerland

[8] Hop Univ Geneve, Dept Anesthesiol Pharmacol & Soins Intensifs, Geneva, Switzerland

[9] Sorbonne Univ Paris 06 UPMC, AP HP, Hop Pitie Salpetriere, ACT Study Grp,Inserm UMR S 1166,Inst Cardiol,Dept, F-75013 Paris, France

[10] CHU Dijon Bourgogne, Plateau Tech Biol, Serv Hematol Biol, Sect Hemostase,5,Blvd Jeanne Arc, F-21000 Dijon, France

[11] Hop Erasme, Dept Anesthesie Reanimat, Brussels, Belgium

[12] Hop Univ Tours, Dept Hematol Hemostase, 2 Blvd Tonnelle, F-37044 Tours, France

[13] Fdn Adolphe de Rothschild, Dept Neuroradiol Intervent, 29 Rue Manin, F-75019 Paris, France

[14] Hop Bichat Claude Bernard, INSERM, U 1148, 46 Rue Henri Huchard, F-75877 Paris, France

[15] CHU Reims, Pole Biol, Serv Hematol Biol, Rue Gen Koenig, F-51100 Reims, France

[16] Univ Lille, INSERM, U1011, EGID, 42 Rue Paul Duez, F-59000 Lille, France

[17] Inst Pasteur, 1 Rue Prof Calmette, F-59000 Lille, France

[18] CHU Lille, Pole Chirurg Cardiaque, 2 Ave Oscar Lambret, F-59000 Lille, France

[19] Univ Grenoble Alpes, Dept Anesthesie Reanimat, ThEMAS, TIMC,UMR,CNRS 5525, F-38000 Grenoble, France

[20] Anesthesie, Montreal, PQ, Canada

[21] Hematol Hemostase, Montreal, PQ, Canada

[22] Hematol Hemostase, Caen, France

[23] Hemostase, Rouen, France

[24] Med Vasc, Grenoble, France

[25] Cardiol, Paris, France

[26] Anesthesie Reanimat, Toronto, ON, Canada

[27] Anesthesie Reanimat, Lille, France

[28] Pharmacol, St Etienne, France

[29] Anesthesie Reanimat, Durham, NC USA

[30] Anesthesie, Valence, France

[31] Med Vasc, Ottawa, ON, Canada

[32] Anesthesie, Namur, Belgium

[33] Anesthesie Reanimat, Paris, France

[34] Anesthesie, Beirut, Lebanon

[35] Neurologie, Paris, France

[36] Pneumologie, Paris, France

[37] Pharmacol Clin, St Etienne, France

[38] Hematologie, Marseille, France

[39] Pathol Vasc, Brussels, Belgium

[40] Hematologie, Namur, Belgium

[41] Anesthesie Reanimat, Limoges, France

[42] Anesthesie Reanimat, Brest, France

[43] Anesthesie Reanimat, Bordeaux, France

[44] Med Urgence, Angers, France

[45] Anesthesie Reanimat, Suresnes, France

[46] Hematologie, Montpellier, France

[47] Hematologie, Toulouse, France

[48] Anesthesie Reanimat, Strasbourg, France

[49] Hematol Transfus, Lille, France

[50] Cardiologie, Lille, France

来源：

ANESTHESIE & REANIMATION | 2019年 / 5卷 / 03期

关键词：

Antiplatelet agents; Surgery; Invasive procedures; Bleeding; Thrombosis; Platelet transfusion; RFVIIa; PERCUTANEOUS CORONARY INTERVENTION; CARDIAC-SURGERY PATIENTS; RECOMBINANT FACTOR VIIA; PLATELET-FUNCTION TESTS; IN-VITRO; TRANEXAMIC ACID; ACETYLSALICYLIC-ACID; NONCARDIAC SURGERY; BYPASS SURGERY; INTRACEREBRAL HEMORRHAGE;

D O I：

10.1016/j.anrea.2018.10.003

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

The French Working Group on Perioperative Haemostasis (GIHP) and the French Study Group on Haemostasis and Thrombosis (GFHT) in collaboration with the French Society of Anaesthesia and Intensive Care Medicine (SFAR) drafted up-to-date proposals on the management of antiplatelet therapy for non-elective invasive procedures or bleeding complications. The proposalswere discussed and validated by a vote; all proposals could be assigned with a high strength. Management of oral antiplatelet agents (APA) in emergency requires knowledge on their pharmacokinetic/pharmacodynamics parameters, evaluation of the degree of the alteration of haemostatic competence and the associated bleeding risk. Platelet function testing maybe considered. When APA-induced bleeding risk mayworsen the prognosis, measures should be taken to neutralise antiplatelet therapy by considering not only the efficacy of available means (which can be limited for prasugrel and even more for ticagrelor) but also the risks that these means expose the patient to. The measures include platelet transfusion at the appropriate dose and haemostatic agents (tranexamic acid; rFVIIa for ticagrelor). When possible, postponing non-elective invasive procedures at least for a few hours until the elimination of the active compound (which could compromise the effect of transfused platelets) or if possible a few days (reduction of the effect of APA) should be considered.

引用

页码：218 / 237

页数：20

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