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HNO-Operationen bei Patienten mit Gerinnungs- und Thrombozytenaggregationshemmung

ENT surgery in patients with anticoagulants and platelet aggregation inhibitors

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Zusammenfassung

Hintergrund

Patienten, die Thrombozytenaggregationshemmer und Antikoagulanzien (TAH/A) einnehmen, stellen einen wesentlichen Teil des Hals-Nasen-Ohren(HNO)-Patientengutes dar. Trotz der Notwendigkeit, zwischen Blutungsrisiko und ischämischem bzw. thrombembolischem Risiko abzuwägen, liegen keine generellen Empfehlungen zum perioperativen Umgang für die HNO-Heilkunde vor.

Ziel der Arbeit

Es sollen Empfehlungen zum perioperativen Management von Patienten mit TAH/A, unter Berücksichtigung spezifischer Problemkonstellationen der Kopf-Hals-Chirurgie, erarbeitet werden.

Material und Methoden

Es wurden 400 zufällig ausgewählte Patienten hinsichtlich der Analgetikaeinnahme bei akuten Schmerzen befragt. Retrospektiv wurden 5211 operierte Patienten hinsichtlich der Einnahme von TAH/A analysiert. Das therapeutische Konzept, der perioperative Umgang mit TAH/A, die Dauer des intensivmedizinischen und gesamten Krankenhausaufenthalts (IS-/K-VD), die Gabe von Erythrozytenkonzentraten und internistische bzw. neurologische Komplikationen wurden erfasst und den Daten von Patienten mit perioperativ pausierter TAH/A gegenübergestellt.

Ergebnisse

Fast 75 % der Patienten nahmen TAH/A aufgrund einer koronaren Herzkrankheit (KHK), peripheren arteriellen Verschlusserkrankung (pAVK), Herzrhythmusstörungen oder zerebrovaskulären Erkrankung ein. Die durchgeführte Umfrage ergab, dass 31 % der Befragten azetylsalizylsäurehaltige Präparate bei akuten Schmerzen einnahmen, was sich in einem Anteil von 10 % der unter TAH/A operierten Patienten widerspiegelte. Für Operationen unter TAH/A zeigte sich ein erhöhtes Blutungsrisiko (p = 0,006), ohne dass eine erhöhte Zahl an internistischen bzw. neurologischen Komplikationen auftrat. Die IS-D und die K-VD waren erhöht (p = 0,006; p = 0,0004).

Diskussion

Grundsätzlich sind HNO-Operationen unter TAH/A durchführbar. Allerdings sollten aufgrund der erhöhten Anforderungen an das Atemwegsmanagment Indikationen zur intensiven Überwachung, Schutzintubation und Tracheotomie großzügig gestellt werden. In enger interdisziplinärer Zusammenarbeit muss das Risiko von Blutungsereignissen und Ischämien bzw. Thrombembolien beurteilt werden.

Abstract

Background

Patients with antiplatelet and antithrombotic therapy (AP/AT) represent a substantial proportion of ear, nose and throat (ENT) patients. Despite the ubiquitous consideration of bleeding and ischemic/thrombembolic risk, no detailed assessment of the perioperative setting in an ENT cohort is available in the literature.

Objectives

The goal of the present work is to give a detailed assessment of patients with AP/AT in an ENT cohort resulting in ENT-specific recommendations for daily routine.

Materials and methods

In all, 400 randomized patients were asked regarding analgetic therapy in acute pain. Medical data of 5211 patients who underwent head and neck surgery were analyzed for AP/AT therapy. Therapeutic strategies, the perioperative AP/AT therapy, duration of intensive care treatment and hospitalization (ICT/H), application of erythrocytes and internistic/neurolocigal complication data were analyzed in patients with/without AP/AT.

Results

Nearly 75 % of our patients were taking AP/AT due to coronary heart disease (CHD), peripheral arterial disease (PAD), cardiac arrhythmia, or cardiovascular disease (CVD). Patients’ questionnaire revealed that 31 % of our patients use acetylsalicylic acid in acute pain, which represents 10 % of the overall AP/AT cohort. Head and neck surgery in patients with AP/AT showed an elevated bleeding frequency (p = 0.006) without an elevated risk for internistic/neurological complications. ICT/H were remarkably prolonged (p = 0.006; p = 0.0004).

Discussion

Head and neck surgery in patients with AP/AT can be routinely performed. Indication for intensive care, endotracheal intubation, and tracheostomy should be made generously due to high requirements of airway management in ENT. Ischemic/thrombembolic and bleeding risk requires careful assessment in an interdisciplinary setting.

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Literatur

  1. Statistisches Bundesamt. Fachserie 12. 12 6.2.1, 7

  2. Urashima M, Hama T, Suda T et al (2013) Distinct effects of alcohol consumption and smoking on genetic alterations in head and neck carcinoma. PLoS One 8:e80828

    Article  PubMed Central  PubMed  Google Scholar 

  3. Teymoortash A, Krasnewicz Y, Werner JA (2006) Clinical features of cystadenolymphoma (Warthin’s tumor) of the parotid gland: a retrospective comparative study of 96 cases. Oral Oncol 42:569–573

    Article  CAS  PubMed  Google Scholar 

  4. Sadetzki S, Oberman B, Mandelzweig L et al (2008) Smoking and risk of parotid gland tumors: a nationwide case-control study. Cancer 112:1974–1982

    Article  PubMed  Google Scholar 

  5. Schlitt A, Jambor C, Spannagl M et al (2013) The perioperative management of treatment with anticoagulants and platelet aggregation inhibitors. Dtsch Arztebl Int 110:525–532

    PubMed Central  PubMed  Google Scholar 

  6. Mega JL, Close SL, Wiviott SD et al (2009) Cytochrome P450 genetic polymorphisms and the response to prasugrel: relationship to pharmacokinetic, pharmacodynamic, and clinical outcomes. Circulation 119(19):2553–2560

    Article  CAS  PubMed  Google Scholar 

  7. Giannitsis E, Katus HA (2012) Antiplatelet therapy – ticagrelor. Hamostaseologie 32:177–185

    Article  CAS  PubMed  Google Scholar 

  8. Rabadi MH, Blass JP (2008) Randomized clinical stroke trials in 2006. Curr Vasc Pharmacol 6:61–66

    Article  CAS  PubMed  Google Scholar 

  9. Wada R, Rohatagi S, Small D et al (2010) Correlation of inhibition of platelet aggregation with cardiovascular and bleeding outcomes in acute coronary syndromes. J Clin Pharmacol 50:904–913

    Article  PubMed  Google Scholar 

  10. Cheng JW, Barillari G (2014) Non-vitamin K antagonist oral anticoagulants in cardiovascular disease management: evidence and unanswered questions. J Clin Pharm Ther (Epub ahead of print)

  11. Cooper JS, Pajak TF, Forastiere AA et al (2004) Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 350:1937–1944

    Article  PubMed  Google Scholar 

  12. Eichhorn W, Barsukov E, Al-Dam A et al (2013) Postoperative bleeding risk for cutaneous surgery in the head and neck region with continued phenprocoumon therapy. J Craniomaxillofac Surg (Epub ahead of print)

  13. Carrel TP, Klingenmann W, Mohacsi PJ et al (1999) Perioperative bleeding and thromboembolic risk during non-cardiac surgery in patients with mechanical prosthetic heart valves: an institutional review. J Heart Valve Dis 8:392–398

    CAS  PubMed  Google Scholar 

  14. Camm AJ, Lip GY, De CR et al (2012) 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation–developed with the special contribution of the European Heart Rhythm Association. Europace 14:1385–1413

    Article  PubMed  Google Scholar 

  15. Trappe HJ (2012) Atrial fibrillation: established and innovative methods of evaluation and treatment. Dtsch Arztebl Int 109:1–7

    PubMed Central  PubMed  Google Scholar 

  16. Vahanian A, Alfieri O, Andreotti F et al (2012) Guidelines on the management of valvular heart disease (version 2012): the joint task force on the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg 42:S1–S44

    Article  PubMed  Google Scholar 

  17. S3 Leitlinie Prophylaxe der venösen Thromboembolie (VTE). http://www.dga-gefaessmedizin.de/uploads/media/LL.VTE._2009.03.18.pdf. Zugegriffen: 17. Februar 2014

  18. Lahtela H, Rubboli A, Schlitt A et al (2012) Heparin bridging vs. uninterrupted oral anticoagulation in patients with Atrial Fibrillation undergoing Coronary Artery Stenting. Results from the AFCAS registry. Circ J 76:1363–1368

    Article  CAS  PubMed  Google Scholar 

  19. Siegal D, Yudin J, Kaatz S et al (2012) Periprocedural heparin bridging in patients receiving vitamin K antagonists: systematic review and meta-analysis of bleeding and thromboembolic rates. Circulation 126:1630–1639

    Article  CAS  PubMed  Google Scholar 

  20. Graham I, Atar D, Borch-Johnsen K et al (2007) European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur J Cardiovasc Prev Rehabil 14:E1–E40

    Article  PubMed  Google Scholar 

  21. Rade JJ, Hogue CW Jr (2008) Noncardiac surgery for patients with coronary artery stents: timing is everything. Anesthesiology 109:573–575

    Article  PubMed Central  PubMed  Google Scholar 

  22. Jambor C, Spannagl M, Zwissler B (2009) Perioperative management of patients with coronary stents in non-cardiac surgery. Anaesthesist 58:971–985

    Article  CAS  PubMed  Google Scholar 

  23. Poldermans D, Bax JJ, Boersma E et al (2010) Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery: the Task Force for Preoperative Cardiac Risk Assessment and Perioperative Cardiac Management in Non-cardiac Surgery of the European Society of Cardiology (ESC) and endorsed by the European Society of Anaesthesiology (ESA). Eur J Anaesthesiol 27:92–137

    Article  PubMed  Google Scholar 

  24. Burger W, Chemnitius JM, Kneissl GD, Rucker G (2005) Low-dose aspirin for secondary cardiovascular prevention – cardiovascular risks after its perioperative withdrawal versus bleeding risks with its continuation – review and meta-analysis. J Intern Med 257:399–414

    Article  CAS  PubMed  Google Scholar 

  25. Sylvester DC, Coatesworth AP (2012) Antiplatelet therapy in ENT surgery: a review. J Laryngol Otol 126:331–336

    Article  CAS  PubMed  Google Scholar 

  26. Sharma AK, Ajani AE, Hamwi SM et al (2004) Major noncardiac surgery following coronary stenting: when is it safe to operate? Catheter Cardiovasc Interv 63:141–145

    Article  PubMed  Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt. A. Knopf, L. Freudelsperger, T. Stark und E. Scherer geben an, dass kein Interessenkonflikt vorliegt.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Hals-Nasen-Ohrenklinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Deutschland

    A. Knopf, L. Freudelsperger, T. Stark & E. Scherer

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  1. A. Knopf
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  2. L. Freudelsperger
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  3. T. Stark
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  4. E. Scherer
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Correspondence to A. Knopf.

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Knopf, A., Freudelsperger, L., Stark, T. et al. HNO-Operationen bei Patienten mit Gerinnungs- und Thrombozytenaggregationshemmung. HNO 62, 350–357 (2014). https://doi.org/10.1007/s00106-014-2843-3

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  • DOI: https://doi.org/10.1007/s00106-014-2843-3

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