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  • Практические аспекты антитромботической терапии у пациентов, нуждающихся в длительном приеме пероральных антикоагулянтов, при проведении хирургических вмешательств

Практические аспекты антитромботической терапии у пациентов, нуждающихся в длительном приеме пероральных антикоагулянтов, при проведении хирургических вмешательств

И. В. Корнелюк, С. Е. Алексейчик, М. Н. Корнелюк УО «Белорусский государственный медицинский университет», г. Минск, Республика Беларусь, Республиканский научно-практический центр «Кардиология», г. Минск, Республика Беларусь
DOI:  https://doi.org/10.51922/1818-426X.2026.3.51
2026 №3 | Обзоры
Аннотация
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У пациентов, нуждающихся в длительной антикоагулянтной профилактике тромбоэмболических осложнений, необходимость и длительность отмены пероральных антикоагулянтов при оперативном вмешательстве зависит от баланса риска кровотечения и тромбоза, а также от типа антикоагулянтов. В статье приводится классификация хирургических вмешательств по степени риска периоперационного кровотечения. При операциях с минимальным риском кровотечения отмены пероральных антикоагулянтов не требуется. При среднем и высоком риске кровотечения необходимо преры- вание приема пероральных антикоагулянтов. Срок отмены прямых пероральных антикоагулянтов короче, чем при использовании варфарина. Потребность в бридж-терапии парентеральными антикоагулянтами зависит от риска тромбоза и длительности отмены пероральных антикоагулянтов. Выделены группы пациентов с очень высоким риском тромбоза. При низком и умеренном риске тромбоза и кратковременном прерывании приема пероральных антикоагулянтов бриджерапия не требуется. При очень высоком риске тромбоза и/или длительном периоде отмены пероральных антикоагулянтов рекомендована бриджерапия на период прерывания приема пероральных антикоагулянтов.
Ключевые слова:
фибрилляция предсердий, пероральные антикоагулянты, геморрагические и тромботические осложнения
Practical aspects of antithrombotic therapy in patients requiring long-term oral anticoagulants during surgical interventions

Some patients require long-term oral anticoagulants. The need for and duration of discon- tinuation of oral anticoagulants if surgical intervention is necessary depends on the balance of bleeding and thrombotic risks and the type of anticoagulant. This article classifies surgical procedures based on the risk of perioperative bleeding. For procedures with minimal bleeding risk, discontinuing oral anticoagulants is not required. For procedures with moderate to high bleeding risk, discontinuing oral anticoagulants is necessary. The withdrawal period for direct oral anticoagulants is shorter than with warfarin. The need for bridge therapy with parenteral anti- coagulants depends on the risk of thrombosis and the duration of oral anticoagulant withdrawal. Groups of patients with a very high risk of thrombosis have been identified. For those with a low to moderate risk of thrombosis and a short-term interruption of oral anticoagulants, bridging therapy is not required. In cases of very high risk of thrombosis and/or prolonged period of withdrawal of oral anticoagulants, bridge therapy is recommended during the period of interruption of oral anticoagulant use.

Keywords
atrial fibrillation, antithrombotic therapy, oral anticoagulants, hemorrhagic and thrombotic complications
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