Medications management of preoperative basic diseases in thoracic surgery

doi:10.3877/cma.j.issn.2095-8773.2022.04.10

Abstract

Abstract:

Perioperative medication management is important for patients with chronic diseases undergoing thoracic surgery. To ensure optimal medication use preoperatively, chronic disease medication management strategies need to consider both clinical needs of patients and surgical risks associated with medications use. At present, perioperative medication management strategies for thoracic surgery patients are mainly based on guidelines and expert opinions for general surgery, which include limited evidence from randomized trials. Few resources summarized the perioperative medication management strategies specific to thoracic surgery. According to the current literature, this paper summarized strategies for managing common chronic disease medications including antiplatelet, anticoagulant, antihypertensive, diabetes, respiratory, and neurological drugs prior to thoracic surgery. This article also introduced the related clinical studies, clinical guidelines, and expert consensus. This article can serve as a reference for perioperative medication management in patients undergoing thoracic surgery and also provide insight into areas that require future research.

Key words: Thoracic surgery, Perioperative medication manegement, Antiplatelet drug, Anticoagulant drug, Antihypertensive drug

Yiwei Yin, Zheng Jiao, Wentao Fang. Medications management of preoperative basic diseases in thoracic surgery[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2022, 09(04): 255-263.

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References 49

1	Jirón M，Pate V，Hanson LC，et al．Trends in Prevalence and Determinants of Potentially Inappropriate Prescribing in the United States: 2007 to 2012[J]．J Am Geriatr Soc，2016，64（4）：788-797．
2	Johnell K，Klarin I．The relationship between number of drugs and potential drug-drug interactions in the elderly: a study of over 600,000 elderly patients from the Swedish Prescribed Drug Register[J]．Drug Saf，2007，30（10）：911-918．
3	Nanji KC，Patel A，Shaikh S，et al．Evaluation of Perioperative Medication Errors and Adverse Drug Events[J]．Anesthesiology，2016，124（1）：25-34．
4	Kristensen SD，Knuuti J，Saraste A，et al．2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA)[J]．Eur Heart J，2014，35（35）：2383-2431．
5	Sakai T，Aokage K，Katsumata S，et al．Continuation of aspirin perioperatively for lung resection: a propensity matched analysis[J]．Surg Today，2021，51（6）：1054-1060．
6	Stamenovic D，Schneider T，Messerschmidt A．Aspirin for patients undergoing major lung resections: hazardous or harmless?†[J]．Interact Cardiovasc Thorac Surg，2019，28（4）：535-541．
7	Yu WS，Jung HS，Lee JG，et al．Safety of thoracoscopic surgery for lung cancer without interruption of anti-platelet agents[J]．J Thorac Dis，2015，7（11）：2024-2032．
8	Fleisher LA，Fleischmann KE，Auerbach AD，et al．2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines[J]．Circulation，2014，130（24）：e278-e333．
9	Chassot PG，Delabays A，Spahn DR．Perioperative antiplatelet therapy: the case for continuing therapy in patients at risk of myocardial infarction[J]．Br J Anaesth，2007，99（3）：316-328．
10	Patel PA，Fleisher LA．Aspirin, clopidogrel, and the surgeon[J]．Adv Surg，2014，48：211-222．
11	Devereaux PJ，Mrkobrada M，Sessler DI，et al．Aspirin in patients undergoing noncardiac surgery[J]．N Engl J Med，2014，370（16）：1494-1503．
12	Wolff G，Navarese EP，Brockmeyer M，et al．Perioperative aspirin therapy in non-cardiac surgery: A systematic review and meta-analysis of randomized controlled trials[J]．Int J Cardiol，2018，258：59-67．
13	Burger W，Chemnitius JM，Kneissl GD，et al．Low-dose aspirin for secondary cardiovascular prevention - cardiovascular risks after its perioperative withdrawal versus bleeding risks with its continuation - review and meta-analysis[J]．J Intern Med，2005，257（5）：399-414．
14	Ferraris VA，Saha SP，Oestreich JH，et al．2012 update to the Society of Thoracic Surgeons guideline on use of antiplatelet drugs in patients having cardiac and noncardiac operations[J]．Ann Thorac Surg，2012，94（5）：1761-1781．
15	Mahla E，Tantry US，Schoerghuber M，et al．Platelet Function Testing in Patients on Antiplatelet Therapy before Cardiac Surgery[J]．Anesthesiology，2020，133（6）：1263-1276．
16	Baron TH，Kamath PS，McBane RD．Management of antithrombotic therapy in patients undergoing invasive procedures[J]．N Engl J Med，2013，368（22）：2113-2124．
17	Douketis JD，Spyropoulos AC，Kaatz S，et al．Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation[J]．N Engl J Med，2015，373（9）：823-833．
18	January CT，Wann LS，Calkins H，et al．2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons[J]．Circulation，2019，140（2）：e125-e151．
19	围术期出凝血管理麻醉专家共识协作组．围术期出凝血管理麻醉专家共识[J]．中华麻醉学杂志，2020，40（9）：1042-1053．
20	Jaffer AK，Brotman DJ，Chukwumerije N．When patients on warfarin need surgery[J]．Cleve Clin J Med，2003，70（11）：973-984．
21	Schulman S，Elbazi R，Zondag M，et al．Clinical factors influencing normalization of prothrombin time after stopping warfarin: a retrospective cohort study[J]．Thromb J，2008，6：15．
22	Douketis JD，Spyropoulos AC，Duncan J，et al．Perioperative Management of Patients With Atrial Fibrillation Receiving a Direct Oral Anticoagulant[J]．JAMA Intern Med，2019，179（11）：1469-1478．
23	Raval AN，Cigarroa JE，Chung MK，et al．Management of Patients on Non-Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting: A Scientific Statement From the American Heart Association[J]．Circulation，2017，135（10）：e604-e633．
24	Roshanov PS，Rochwerg B，Patel A，et al．Withholding versus Continuing Angiotensin-converting Enzyme Inhibitors or Angiotensin II Receptor Blockers before Noncardiac Surgery: An Analysis of the Vascular events In noncardiac Surgery patIents cOhort evaluatioN Prospective Cohort[J]．Anesthesiology，2017，126（1）：16-27．
25	Howell SJ．Consensus statements and expert guidance: interpret with care[J]．Br J Anaesth，2019，122（6）：719-722．
26	Ziegler CH，Lovette JB．Operative complications after therapy with reserpine and reserpine compounds[J]．JAMA，1961，176：916-919．
27	Munson WM，Jenicek JA．Effect of anesthetic agents on patients receiving reserpine therapy[J]．Anesthesiology，1962，23：741-746．
28	Irizarry-Alvarado JM．Perioperative Management of Beta Blockers and Other Antiarrhythmic Medications[J]．Curr Clin Pharmacol，2017，12（3）：141-144．
29	Lazar HL，McDonnell M，Chipkin SR，et al．The Society of Thoracic Surgeons practice guideline series: Blood glucose management during adult cardiac surgery[J]．Ann Thorac Surg，2009，87（2）：663-669．
30	American Diabetes Association Professional Practice Committee；Draznin B，Aroda VR，et al．9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes-2022[J]．Diabetes Care，2022，45（Suppl 1）：S125-S143．
31	Duggan EW，Carlson K，Umpierrez GE．Perioperative Hyperglycemia Management: An Update[J]．Anesthesiology，2017，126（3）：547-560．
32	Preiser JC，Provenzano B，Mongkolpun W，et al．Perioperative Management of Oral Glucose-lowering Drugs in the Patient with Type 2 Diabetes[J]．Anesthesiology，2020，133（2）：430-438．
33	Thiruvenkatarajan V，Jesudason D，Nanjappa N，et al．Perioperative Management of Glucose-lowering Drugs: Comment[J]．Anesthesiology，2021，134（2）：349-350．
34	Cheisson G，Jacqueminet S，Cosson E，et al．Perioperative management of adult diabetic patients. Review of hyperglycaemia: definitions and pathophysiology[J]．Anaesth Crit Care Pain Med，2018，37 Suppl 1：S5-S8．
35	Membership of the Working Party；Barker P，Creasey PE，et al．Peri-operative management of the surgical patient with diabetes 2015: Association of Anaesthetists of Great Britain and Ireland[J]．Anaesthesia，2015，70（12）：1427-1440．
36	Hulst AH，Polderman JAW，Siegelaar SE，et al．Preoperative considerations of new long-acting glucagon-like peptide-1 receptor agonists in diabetes mellitus[J]．Br J Anaesth，2021，126（3）：567-571．
37	Pfeifer KJ，Selzer A，Whinney CM，et al．Preoperative Management of Gastrointestinal and Pulmonary Medications: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement[J]．Mayo Clin Proc，2021，96（12）：3158-3177．
38	Renew JR，Aniskevich S．Perioperative Pulmonary Medication Management[J]．Curr Clin Pharmacol，2017，12（3）：182-187．
39	Oprea AD，Keshock MC，O'Glasser AY，et al．Preoperative Management of Medications for Psychiatric Diseases: Society for Perioperative Assessment and Quality Improvement Consensus Statement[J]．Mayo Clin Proc，2022，97（2）：397-416．
40	Zafirova Z，Vázquez-Narváez KG，Borunda D．Preoperative Management of Medications[J]．Anesthesiol Clin，2018，36（4）：663-675．
41	Jamal BT，Herb K．Perioperative management of patients with myasthenia gravis: prevention, recognition, and treatment[J]．Oral Surg Oral Med Oral Pathol Oral Radiol Endod，2009，107（5）：612-615．
42	Liu MM，Reidy AB，Saatee S，et al．Perioperative Steroid Management: Approaches Based on Current Evidence[J]．Anesthesiology，2017，127（1）：166-172．
43	徐建国，唐会，姚尚龙，等．肾上腺糖皮质激素围手术期应用专家共识(2017版)[J]．临床麻醉学杂志，2017，33（7）：712-716．
44	Farmakidis C，Pasnoor M，Dimachkie MM，et al．Treatment of Myasthenia Gravis[J]．Neurol Clin，2018，36（2）：311-337．
45	Vinogradova Y，Coupland C，Hippisley-Cox J．Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases[J]．BMJ，2019，364：k4810．
46	Pfeifer KJ，Selzer A，Mendez CE，et al．Preoperative Management of Endocrine, Hormonal, and Urologic Medications: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement[J]．Mayo Clin Proc，2021，96（6）：1655-1669．
47	Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures: An Updated Report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration[J]．Anesthesiology，2017，126（3）：376-393．
48	Dobson G，Chong M，Chow L，et al．Guidelines to the Practice of Anesthesia - Revised Edition 2018[J]．Can J Anaesth，2018，65（1）：76-104．
49	Smith I，Kranke P，Murat I，et al．Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology[J]．Eur J Anaesthesiol，2011，28（8）：556-569．

药品		推荐意见
COX受体拮抗剂
	阿司匹林	一级预防患者可在术前停药7天
	阿司匹林	二级预防及PCI术后患者需要评估患者的手术出血风险及停药风险，综合考虑是否停药
P2Y12受体拮抗剂
	氯吡格雷及替格瑞洛	血栓风险低的患者可在术前5天停药
	替格瑞洛	血栓风险低的患者可在术前3天停药
	替格瑞洛	血栓风险高或PCI术后的患者需要评估患者的手术出血风险及停药风险，综合考虑是否停药
其他抗血小板药物
	西洛他唑及双嘧达莫	血栓风险低的患者可在术前2~3天停药
	西洛他唑及双嘧达莫	血栓风险高或PCI术后的患者需要评估患者的手术出血风险及停药风险，综合考虑是否停药

药品		推荐意见
COX受体拮抗剂
	阿司匹林	一级预防患者可在术前停药7天
	阿司匹林	二级预防及PCI术后患者需要评估患者的手术出血风险及停药风险，综合考虑是否停药
P2Y12受体拮抗剂
	氯吡格雷及替格瑞洛	血栓风险低的患者可在术前5天停药
	替格瑞洛	血栓风险低的患者可在术前3天停药
	替格瑞洛	血栓风险高或PCI术后的患者需要评估患者的手术出血风险及停药风险，综合考虑是否停药
其他抗血小板药物
	西洛他唑及双嘧达莫	血栓风险低的患者可在术前2~3天停药
	西洛他唑及双嘧达莫	血栓风险高或PCI术后的患者需要评估患者的手术出血风险及停药风险，综合考虑是否停药

药品		推荐意见
维生素K拮抗剂
	华法林	依据目标INR值与患者实际INR值制定停药计划，通常需停药3~5天；手术前未达到目标值可用维生素K拮抗
新型口服抗凝药
	利伐沙班	术前2~3天
	阿哌沙班	术前2~3天
	依度沙班	术前2~3天
	达比加群	肌酐清除率>50 mL/min：术前2~3天；肌酐清除率≤50 mL/min：术前4~5天
注射用抗凝药物
	肝素钠	静脉注射（治疗剂量）：术前4~6 h；皮下注射（预防剂量）：术前12~24 h
	低分子肝素	治疗剂量：术前24 h；预防剂量：术前12 h
	磺达肝素钠	术前3~5天
	阿加曲班	术前3 h

药品		推荐意见
维生素K拮抗剂
	华法林	依据目标INR值与患者实际INR值制定停药计划，通常需停药3~5天；手术前未达到目标值可用维生素K拮抗
新型口服抗凝药
	利伐沙班	术前2~3天
	阿哌沙班	术前2~3天
	依度沙班	术前2~3天
	达比加群	肌酐清除率>50 mL/min：术前2~3天；肌酐清除率≤50 mL/min：术前4~5天
注射用抗凝药物
	肝素钠	静脉注射（治疗剂量）：术前4~6 h；皮下注射（预防剂量）：术前12~24 h
	低分子肝素	治疗剂量：术前24 h；预防剂量：术前12 h
	磺达肝素钠	术前3~5天
	阿加曲班	术前3 h

药品		推荐意见
抗高血压药物
	ACEI（如卡托普利）、ARB（如氯沙坦）	术前24 h
	钙离子通道阻滞剂（如氨氯地平）、β受体阻滞剂（如美托洛尔）、α受体阻滞剂（如哌唑嗪）及扩血管药物（如肼屈嗪）	除患者存在禁忌证外，可不调整治疗方案
	利血平	建议术前7~14天停药
抗心律失常药物（如胺碘酮、普罗帕酮）		除患者存在禁忌证外，可不调整治疗方案

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