口服抗凝血劑病患術前處置－－案例報告

Oral Anticoagulant Patients with A Preoperative Disposal--A Case Report

口服抗凝血劑病人易有低凝血因子，需隨時監測病人凝血酵素原時間（PT）。當出現延長時可能會導致相關出血的併發症，例如顱內出血、腸胃道出血、口腔黏膜或牙齦出血、皮下瘀青、血尿等。而致命的出血副作用則屬腦溢血[1] ，這類年齡大於65 歲的年老病患發生顱內出血的併發症，每年確定有0.3~0.6％ 的發生機率[1,2,3]。本案例為78 歲冠心症男性患者，長期口服抗凝血劑，突然發生腦溢血，須緊急開顱手術時，實驗室檢查發現其凝血酵素原時間（PT）延長，血小板低，術前有出血傾向。我們將介紹口服抗凝血劑病患接受手術時，術前如何評估出血問題並使用跨接療法，以降低出血及減少栓塞的發生。在緊急手術時又該如何快速補充足夠的凝血因子，矯正凝血時間，以降低術中、後的嚴重出血，以期能提高手術的安全性。

Oral anticoagulant patients can easily induce low hemoglutination factors. So their prothrombin time (PT) has to be monitored closely. When the time is prolonged, it causes relative bleeding syndromes, such as intracranial hemorrhage, gastrointestinal bleeding, oral mucosa or gums oozing, subcutaneous ecchymosis, hematuria et al. A spontaneous hemorrhagic stroke is the most serious complication, occurring in the elderly more than 65 years of age at a rate 0.3 to 0.6 % per year. The case report is a 78-years-old male who took long-term oral anticoagulants for CAD, and subsequently suffered from a spontaneous hemorrhagic stroke. He had an emergency craniotomy with preoperative bleeding tendency, prolonging PT and low platelet count in laboratory data. Therefore, we introduce the method of evaluating the bleeding problems and how to use bridging therapy to reduce bleeding and prevent thrombin in those patients for regulatory surgery. In addition, we will discuss how to transfuse coagulation factors for correcting rapid bleeding in an emergency and for reducing operative and postoperative serious bleeding problems so operative safety can be increased.