周術期の抗血栓療法をヘパリンに置換した手術症例の検討

Abstract

Anticoagulant and antiplatelet medications are commonly used for the treatment and prevention of cardiovascular diseases. We studied 84 patients who received heparin as a bridging anticoagulant and antiplatelet therapy during the perioperative period. Hospitalization was extended for adjusting anticoagulant and antiplatelet drugs and also bleeding complications in the perioperative period. There were 25 instances of bleeding complications (29.7%) in this study. These complications mainly occurred when anticoagulant and antiplatelet medications were restarted in the postoperative period. In transurethral surgery, patients taking warfarin and antiplatelet drugs (aspirin or ticlopidine) had a statistically significant increase in bleeding complications compared to patients taking warfarin alone. We compared 51 cases of transurethral resection of bladder tumor, transurethral resection of the prostate holium laser enucleation of the prostate, nephroureterectomy and percutaneous nephrolithotomy with heparinization were compared to 692 cases with no heparinization. The heparinization group had a statistically significant longer hospitalization period and an increase in bleeding complications. There was one instance of thromboembolism (1.2%) in our series. This involved stent thrombosis of a patient who had drug-eluting stent in the left anterior descending coronary artery. She died three days postoperatively. The number of patients taking anticoagulant and/or antiplatelet drugs is predicted to increase in the future due to aging of the population. Guidelines for the management of anticoagulant and antiplatelet therapy in the urological period are considered necessary.