下肢大关节手术围手术期抗凝治疗

静脉血栓栓塞症(venous thromboembolism, VTE)包括深静脉血栓形成和肺血栓栓塞症, 是下肢大关节手术后发生率高且后果严重的并发症, 因此术后抗凝治疗预防VTE受到越来越多骨科医师的重视。随着国内外抗凝治疗指南的推广应用, 下肢大关节手术后VTE发生风险及死亡率明显降低, 对此类患者术后常规抗凝治疗已成为骨科医师共识; 然而, 目前对于具体抗凝方案及疗程选择, 是否需要联合用药, 以及对合并复杂基础疾病患者的围手术期抗凝等问题仍有争议。本文对下肢大关节手术围手术期常用抗凝药物、抗凝方案、抗凝风险和并发症以及复杂情况下的抗凝治疗进行阐述。

Anticoagulant Therapy for Perioperative Management of Major Lower Limb Joint Surgery

Venous thromboembolism (VTE), comprised of deep vein thrombosis and pulmonary thromboembolism, is a severe complication with a high incidence after major lower limb joint surgery, which has been drawing more of orthopedic surgeons' attention to the preventive treatment. With the development and application of the guidelines of anticoagulant treatment, the risk and the mortality of VTE have been decreased dramatically, and the consensus that anticoagulation is routinely applied to these patients has been reached among orthopedic surgeons. However, controversies remain in the aspects encompassing the choice of specific regimen, short or long course of anticoagulant treatment, the necessity of drug combination, and the anticoagulant plans for those with complex comorbidities. Therefore, the anticoagulant medications, the selection of prophylactic regimen, the risks and complications of anticoagulation, and the optimal anticoagulant plans for complex cases are discussed in the current review.