Rejyonel Anestezide Antikoagulan İlaç Kullanımı.

Yazarlar

Erdinç Koca

Özet

Bu çalışma, rejyonel anestezi uygulamalarında antikoagülan ve antitrombotik tedavi alan hastalarda gelişebilecek olası komplikasyonları, risk faktörlerini ve uluslararası dernek rehberleri (ASRA, ESA, SSAI, ASIPP) ışığında ilaçların kesilme ve yeniden başlanma zamanlarını ayrıntılı şekilde incelemektedir. Ultrasonografi kullanımıyla rejyonel blok komplikasyonları azalsa da, yeni jenerasyon antikoagülan ilaçların kullanımının artması spinal hematom ve kalıcı nörolojik hasar riskini gündeme getirmektedir. Spinal hematom gelişme riski spinal anestezide 1/220.000, epidural anestezide 1/150.000 oranında bildirilmiş olup, travmatik girişimler ile perioperatif düşük molekül ağırlıklı heparin (DMAH) kullanımı bu riski önemli ölçüde artırmaktadır. İleri yaş, kadın cinsiyet, omurga anomalileri, böbrek yetmezliği ve çoklu antikoagülan kullanımı diğer başlıca risk faktörleridir. Şüpheli klinik durumlarda ilk sekiz saat içinde yapılacak acil cerrahi müdahale kalıcı nörolojik defisitleri engellemek açısından hayati önem taşır. Yazıda antikoagülanlar (heparin, warfarin, faktör Xa ve direkt trombin inhibitörleri), antiplateletler (aspirin, P2Y12 antagonistleri, GP IIb/IIIa inhibitörleri), trombolitikler, SSRI grubu ilaçlar ve bitkisel desteklerin (sarımsak, ginkgo, ginseng) etki mekanizmaları ile girişimsel prosedürlerin risk seviyelerine (düşük, orta, yüksek) göre yönetim stratejileri açıklanmaktadır. Sonuç olarak, kardiyovasküler tromboemboli riski ile nöroaksiyel kanama riski arasında hassas bir denge gözetilmeli ve ilaç zamanlamaları titizlikle yönetilmelidir.

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