Цитата:
Сообщение от zubarew
Резюмируя, по моему скромному мнению, в настоящее время однозначнойй позиции по этому вопросу нет. Доказательств за и против недостаточно. Теоретически можно взять и раньше, чем спустя 7 дней после отмены плавикса, но нужны убедительные обоснования для этого.
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Вот что-то такое пока и получается. А ведь есть и другая сторона проблемы - отмена плавикса сама по себе чревата тоже. И откладывание операции - летальность на круг только из-за этого выше в разы. Но - в этой ситуации доблестные представители анестезиологической службы оказываются в стороне, как бы непричастные.
J Orthop Surg (Hong Kong). 2007 Dec;15(3):270-2.
Anti-platelet agents and surgical delay in elderly patients with hip fractures.
Harty JA, McKenna P, Moloney D, D'Souza L, Masterson E.
Department of Orthopaedic Surgery, Midwestern Regional Hospital, Dooradoyle, Limerick, Ireland. [
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PURPOSE: To assess the risk of surgical delay in elderly hip
fracture patients on anti-platelet agents. METHODS: Records of
180 patients aged over 65 years with either an intertrochanteric
or femoral neck fracture were reviewed. The clopidogrel group
included 10 patients on clopidogrel alone and 11 others on
clopidogrel and aspirin, whereas the control group included 69 on
aspirin alone and the remaining 90 not on any anti-coagulants.
The 2 groups were compared with regard to time to surgery,
preoperative American Society of Anesthesiologists (ASA) score,
pre- and post-operative haemoglobin levels, in-patient
complication rates, duration of hospital stay, and 30-day
mortality. RESULTS: In the clopidogrel and control groups
respectively, the mean times to surgery were 7.2 and 2.1 days
(p=0.03, t-test), the mean preoperative ASA scores were 3.35 and
2.8 (p=0.29, t-test), the mean preoperative haemoglobin levels
were 119 and 115 g/l (p=0.5, t-test), the mean postoperative
haemoglobin levels were 98 and 96 g/l (p=0.68, t-test), the mean
durations of hospital stay were 7.4 and 3.1 days (p=0.02,
t-test). The 30-day mortalities were 6/21 (29%) and 6/159 (4%)
[p=0.0003, Fisher's exact test]. CONCLUSION: Surgical delay in
elderly patients on anti-platelet agents with hip fracture was
associated with higher mortality. Despite the risk of increased
blood loss, we suggest early surgery be carried out by an
experienced surgeon to expedite the operating time. Pooled
platelets should be given intravenously one to 2 hours
preoperatively.