臨床整形外科53巻10号

2018年10月発行

境界領域/知っておきたい

整形手術前の経口抗血栓薬の休薬指針

著者： 福田芽森¹ 板橋裕史¹

所属機関： ¹慶應義塾大学循環器内科

ページ範囲：P.908 - P.913

　整形外科周術期において抗血栓薬の休薬や再開を検討する際に重要なことは，①抗血栓薬を内服している理由を確認することと，②手術の出血リスクを評価することである．これらの情報から個々の症例における「休薬による血栓性合併症」と「周術期の出血性合併症」のリスクを比較し，周術期に休薬が必要か，また休薬する際にはヘパリンなどの薬剤による置換が必要なのかを検討する必要がある．

　本稿では，以上に留意して整形外科手術前の抗血栓薬の休薬指針を抗血小板薬と抗凝固薬に分けて概説する．なお，国内では日本のガイドラインを遵守するべきという考え方もあるが，欧米のガイドラインにはより新しいエビデンスが反映されているため，本稿では後者の考え方を中心に述べる．

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