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首页> 外文期刊>Cardiovascular therapeutics >Stroke prevention versus bleeding risk of vitamin-K antagonists: a double-edged sword in patients with atrial fibrillation who require surgery.
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Stroke prevention versus bleeding risk of vitamin-K antagonists: a double-edged sword in patients with atrial fibrillation who require surgery.

机译：预防卒中与维生素K拮抗剂的出血风险：需要手术的房颤患者的双刃剑。

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摘要

Patients with atrial fibrillation taking vitamin-K antagonists and undergoing invasive interventions or large surgery procedures are at highest risk of bleeding complications. Therefore, the temporary interruption of vitamin-K antagonists and bridging with heparin is a frequent clinical need, particularly in patients with high risk for stroke. The management of such patients is challenging because of the lack of randomized clinical trials assessing different periprocedural anticoagulation approaches and inconsistent recommendations from consensus groups. Recent non-randomized trials have helped to estimate the risks of thromboembolism and bleeding with "bridging" anticoagulation involving either low-molecular-weight heparin or intravenous unfractioned heparin. Nevertheless, there is still a clear need for randomized double-blinded controlled trials comparing efficacy and safety of the different "bridging" strategies, including unfractionated heparin and placebo comparators, in preventing thromboembolism for specific patients and procedures.
机译：服用维生素K拮抗剂并接受侵入性干预或大手术的心房颤动患者发生出血并发症的风险最高。因此，维生素K拮抗剂的暂时中断和肝素的桥接是临床上经常需要的，特别是在中风风险高的患者中。由于缺乏评估不同的围手术期抗凝治疗方法的随机临床试验以及共识小组的不一致建议，此类患者的治疗具有挑战性。最近的非随机试验通过低分子量肝素或静脉内未分级肝素的“桥接”抗凝治疗，有助于估计血栓栓塞和出血的风险。尽管如此，仍然明显需要进行随机双盲对照试验，以比较不同“桥接”策略（包括普通肝素和安慰剂对照）在预防特定患者和手术过程中血栓栓塞的功效和安全性。

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