Tolga ŞİTİLCİ, Kardelen CAN, Mehmet YALTIRIK

Antiagregan ilaçlar ve nonsteroid antienflamatuar ilaçların postoperatif kanama üzerine etkileri. Hangisinden korkmalıyız?

Antiagregan ilaçlar, trombositlerin agregasyonlarını inhibe eden ilaçlardır. Tromboembolik olay riskinde azalma ile birlikte, cerrahi prosedürler ile bağlantılı kanama riskinde artışa neden olurlar. Antiagregan kullanan hastalarda oral cerrahi sırasında ve sonrasında kanama, lokal hemostatik yöntemlerle kontrol altına alınabilir düzeydedir. Antiagregan tedavinin kesilmesi, tromboembolik olay riskini artırır. Bu nedenle araştırmacılar, oral cerrahi öncesi antiagregan ilaçların kesilmesini gereksiz bulmaktadır. Non-steroid antienflamatuvar ilaçlar (NSAİİ’ler); analjezik, antipiretik ve antienflamatuar etkili ilaçlardır. Ameliyat sonrası analjezi için kullanılabilirler. Ancak trombositlerin agregasyonunu inhibe etmeleri nedeniyle hemostazı yavaşlatırlar ve kanama süresini uzatırlar. NSAİİ kullanan sağlıklı bireylerde kanama zamanı genellikle normal kanama zamanı aralığının üst sınırını geçmez. Antiagregan ilaçlar ve NSAİİ’lerin her ikisi de kanama zamanını uzatır. Yapılan literatür taraması sonucunda, antiagregan ilaçlar ile NSAİİ’lerin kanamaya etkileri arasında farklılık bulunmamıştır. Araştırmalar; perioperatif NSAİİ veya antiagregan kullanımının şiddetli kanama komplikasyonu riskini artırmadığını, oluşan kanamaların lokal hemostatik yöntemlerle iyi yönetilebilir nitelikte olduğunu göstermektedir.

The effects of antiplatelet drugs and nonsterid anti-inflammatory drugs on postoperative bleeding. Which one we should be afraid of?

Antiplatelet drugs inhibit the aggregation of platelets. With a reduced risk of thromboembolic events, they increase the risk of bleeding associated with surgical procedures. In patients who use antiplatelets, bleeding during and after oral surgery can be controlled by local hemostatic methods. Interruption of antiplatelet therapy increases the risk of thromboembolic events. For this reason, researchers find it unnecessary to interrupt antiplatelet drugs before oral surgery. Non-steroidal anti-inflammatory drugs (NSAIDs) have analgesic, antipyretic and antiinflammatory effects. They can be used for post-operative analgesia. However, they inhibit the aggregation of platelets so slow the hemostasis and prolong the duration of bleeding. In healthy individuals using NSAIDs, bleeding time generally does not exceed the upper limit of normal bleeding time interval. Both antiplatelet drugs and NSAIDs prolong bleeding time. As a result of the literature review, there was no difference between the effects of antiplatelet drugs and NSAIDs on bleeding. Surveys show that; perioperative NSAIDs or antiplatelet use does not increase the risk of severe bleeding complications and that bleeding is well manageable with local hemostatic methods.

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