New guidelines on thromboembolism prophylaxis - implications for our specialty

作者：Gogarten W^*; Van Alken H

来源：Anasthesiologie & Intensivmedizin, 2009, 50: 316-+.

• Thromboembolism Prophylaxis
• Timing
• Neuraxial Blockade
• Coronary Artery Stents
• Aspirin
• Heparin-induced Thrombocytopenia

All German specialties have issued new guidelines on thromboembolism prophylaxis in a combined effort. Major issues pertaining to anaesthesiology include heparin-induced thrombocytopenia, timing of thromboembolism prophylaxis, prophylaxis in intensive care units, and the inclusion of guidelines on neuraxial blockade and thromboembolism prophylaxis. A major paradigm shift includes the timing of thromboembolism prophylaxis. There is no evidence that the European approach of starting preoperatively is superior to US regimens with a postoperative start. In addition, newer anticoagulants are only approved postoperatively. Another paradigm shift is the continuation of acetylsalicylic acid in the perioperative period in order to reduce cardiovascular events, especially in patients with recent stent implantation. Although acetylsalicylic acid may increase bleeding, blood losses are usually limited except for patients undergoing neurosurgery, prostate resections or tonsillectomies. In the presence of acetylsalicylic acid, thromboembolism prophylaxis should be started postoperatively in all patients, including patients undergoing neuraxial blockade.

• 出版日期2009-5