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髋关节置换术及髋关节翻修术后患者有发生静脉血栓栓塞症(VTE)的可能[1]。这类患者中有一些既往行冠脉支架植入术需常规口服抗栓药的患者,持续抗血栓治疗可能会导致围术期出血风险增加,而停药又可能导致急性冠状动脉综合征(ACS)和/或动脉血栓栓塞(ATE)发生[2],因此,合适的抗栓方案成为治疗的关键。笔者分析1例冠状动脉支架植入术后髋关节翻修术患者的抗栓治疗策略,并进行文献复习,以期为临床提供参考。
Perioperative antithrombotic therapy in the patient undergoing revision total hip arthroplasty after coronary stent implantation: a case report and literature review
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摘要:
目的 探讨冠状动脉支架植入术后患者行髋关节翻修术围术期抗栓治疗策略。 方法 对1例冠状动脉支架植入术后患者行髋关节翻修术的抗栓治疗进行分析,并进行相关文献复习。 结果 患者术后出现急性非ST段抬高性心肌梗死,系因术前3 d即停用阿司匹林,期间亦未用低分子肝素桥接抗凝所致,并对术后急性冠状动脉综合征抗栓及静脉血栓栓塞症预防方案进行分析。 结论 冠状动脉支架植入术后行髋关节翻修术患者围术期应平衡血栓形成与出血风险,合理选择抗栓治疗方案。 Abstract:Objective To explore the strategies of perioperative antithrombotic therapy in the patient undergoing revision total hip arthroplasty after coronary stent implantation. Methods The antithrombotic therapy in one patient undergoing revision total hip arthroplasty after coronary stent implantation was analyzed with the review of related literatures. Results The patient developed non-ST segment elevated myocardial infarction due to the stop of aspirin three days before operation and no low molecular weight heparin was used. The antithrombotic treatment and prevention of venous thromboembolism were analyzed. Conclusion Antithrombotic therapy should be selected reasonably in patients undergoing revision total hip arthroplasty after coronary stent implantation. -
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