PDF(Pubmed)
Abstract：
UNASSIGNED: To summarize the available evidence about the perioperative management of patients who are receiving long-term antiplatelet therapy and require elective surgery/procedures.
UNASSIGNED: This systematic review supports the development of the American College of Chest Physicians guideline on the perioperative management of antiplatelet therapy. A literature search of MEDLINE, EMBASE, Scopus and Cochrane databases was conducted from each database\'s inception to July 16, 2020. Meta-analyses were conducted when possible.
UNASSIGNED: In patients receiving long-term antiplatelet therapy and undergoing elective noncardiac surgery, the available evidence did not show a significant difference in major bleeding between a shorter vs longer antiplatelet interruption, with low certainty of evidence (COE). Compared with patients who received placebo perioperatively, aspirin continuation was associated with increased risk of major bleeding (relative risk [RR], 1.31; 95% CI, 1.15-1.50; high COE) and lower risk of major thromboembolism (RR, 0.74; 95% CI, 0.58-0.94; moderate COE). During antiplatelet interruption, bridging with low-molecular-weight heparin was associated with increased risk of major bleeding compared with no bridging (RR, 1.86; 95% CI, 1.24-2.79; very low COE). Continuation of antiplatelets during minor dental and ophthalmologic procedures was not associated with a statistically significant difference in the risk of major bleeding (very low COE).
UNASSIGNED: This systematic review summarizes the current evidence about the perioperative management of antiplatelet therapy and highlights the urgent need for further research, particularly with the increasing prevalence of patients taking 1 or more antiplatelet agents.
UNASSIGNED: This systematic review supports the development of the American College of Chest Physicians guideline on the perioperative management of antiplatelet therapy. A literature search of MEDLINE, EMBASE, Scopus and Cochrane databases was conducted from each database\'s inception to July 16, 2020. Meta-analyses were conducted when possible.
UNASSIGNED: In patients receiving long-term antiplatelet therapy and undergoing elective noncardiac surgery, the available evidence did not show a significant difference in major bleeding between a shorter vs longer antiplatelet interruption, with low certainty of evidence (COE). Compared with patients who received placebo perioperatively, aspirin continuation was associated with increased risk of major bleeding (relative risk [RR], 1.31; 95% CI, 1.15-1.50; high COE) and lower risk of major thromboembolism (RR, 0.74; 95% CI, 0.58-0.94; moderate COE). During antiplatelet interruption, bridging with low-molecular-weight heparin was associated with increased risk of major bleeding compared with no bridging (RR, 1.86; 95% CI, 1.24-2.79; very low COE). Continuation of antiplatelets during minor dental and ophthalmologic procedures was not associated with a statistically significant difference in the risk of major bleeding (very low COE).
UNASSIGNED: This systematic review summarizes the current evidence about the perioperative management of antiplatelet therapy and highlights the urgent need for further research, particularly with the increasing prevalence of patients taking 1 or more antiplatelet agents.
摘要：
UNASSIGNED：总结关于接受长期抗血小板治疗并需要择期手术/程序的患者的围手术期管理的现有证据。
UNASSIGNED：本系统综述支持美国胸科医师学会制定关于抗血小板治疗围手术期管理的指南。MEDLINE的文献检索,EMBASE,Scopus和Cochrane数据库是从每个数据库成立到2020年7月16日进行的。在可能的情况下进行荟萃分析。
未经评估：在接受长期抗血小板治疗和择期非心脏手术的患者中，现有证据显示，在较短的抗血小板中断与较长的抗血小板中断之间，大出血没有显着差异，证据确定性(COE)低。与围手术期接受安慰剂的患者相比，继续服用阿司匹林与大出血风险增加相关(相对风险[RR]，1.31；95%CI，1.15-1.50；高COE）和较低的主要血栓栓塞风险（RR，0.74；95%CI，0.58-0.94；中度COE）。在抗血小板中断期间，与无桥接相比,低分子量肝素桥接与大出血风险增加相关(RR,1.86；95%CI，1.24-2.79；极低的COE）。在较小的牙科和眼科手术期间继续使用抗血小板药物与大出血风险（极低的COE）的统计学差异无关。
UNASSIGNED：本系统综述总结了目前关于抗血小板治疗围手术期管理的证据，并强调迫切需要进一步研究，特别是随着服用一种或多种抗血小板药物的患者患病率的增加。
UNASSIGNED：本系统综述支持美国胸科医师学会制定关于抗血小板治疗围手术期管理的指南。MEDLINE的文献检索,EMBASE,Scopus和Cochrane数据库是从每个数据库成立到2020年7月16日进行的。在可能的情况下进行荟萃分析。
未经评估：在接受长期抗血小板治疗和择期非心脏手术的患者中，现有证据显示，在较短的抗血小板中断与较长的抗血小板中断之间，大出血没有显着差异，证据确定性(COE)低。与围手术期接受安慰剂的患者相比，继续服用阿司匹林与大出血风险增加相关(相对风险[RR]，1.31；95%CI，1.15-1.50；高COE）和较低的主要血栓栓塞风险（RR，0.74；95%CI，0.58-0.94；中度COE）。在抗血小板中断期间，与无桥接相比,低分子量肝素桥接与大出血风险增加相关(RR,1.86；95%CI，1.24-2.79；极低的COE）。在较小的牙科和眼科手术期间继续使用抗血小板药物与大出血风险（极低的COE）的统计学差异无关。
UNASSIGNED：本系统综述总结了目前关于抗血小板治疗围手术期管理的证据，并强调迫切需要进一步研究，特别是随着服用一种或多种抗血小板药物的患者患病率的增加。
