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Tắc nghẽn không thể cứu vãn không thể đảo ngược của tắc nghẽn bằng cách sử dụng ADP ADP tiểu cầu tiểu cầu thụ thụ thể ADP tiểu cầu chức năng cụ thể tiểu cầu xét nghiệm kiểm tra chức năng (tỷ lệ aggregometry hoặc tiểu cầu) như một số hoạt hóa tiểu cầu, | Preparation of the Patient for Surgery 153 Melagatgran Ximelagatran Abciximab Eptifibatide Tirofiban Ticlopidine Clopidogrel Dipyridamole Aspirin Flurbiprofen Direct thrombin inhibitor Direct thrombin inhibitor Blocks GPIIb IIIa receptor of platelets GPIIb IIIa inhibitor GPIIb IIIa inhibitor Irreversible blockage of platelet ADP receptor Irreversible blockage of platelet ADP receptor Thromboxane inhibition Thromboxane inhibition May be not needed May be not needed Hemodyne analysis modified TEG Specific platelet function tests aggregometry or platelet count ratio using ADP as an activator platelet count Platelet function assay Chromogenic substrate Chromozym FEIBA rFVIIa Desmopressin Dialysis possibly desmopressin or rFVIIa fibrinogen cryo-ppt Desmopressin fibrinogen cryo-ppt Aprotinin desmopressin rFVIIa plasmapherese Desmopressin Aprotinin value is not yet fully understood. If the surgeon plans treating an anticoagulated patient please refer to the literature for indication and dosages of the proposed agents. full-dose heparin instead of vitamin K antagonists. This permits emergency reversal with protamine if bleeding occurs. Another common anticoagulant is aspirin an antiplatelet agent. It has been documented as a reason for an increased risk of perisurgical bleeding and increased use of transfusion 56 although this effect has not been demonstrated in other studies. The antiplatelet effect of aspirin is pronounced if the patient has taken other anticoagulants has a preexisting problem with hemostasis or if alcohol is taken concurrently 53 . Since aspirin irreversibly inhibits thromboxane synthesis in platelets it is best stopped several days before surgery and the surgeon should wait until functional platelets are produced. Nowadays many other anticoagulants are used in clinical practice. Table 11.5 provides an overview of the existing drugs and potential reversal methods if such become necessary 58-79 . Avoid pharmacologic coagulopathies Many drugs are not used
