Motto

“Corelatia” este diferita de “cauzalitate”

“Plauzibilul” este diferit de “adevarat”
“Simptomaticul” este diferit de “lifesaving”

Anticoagulante orale,
antiagregante plachetare:
cand, cum, cat ?
 Cui (si cat) prescriem dubla - AAG?

Cui (si cat) prescriem ACO(N)?

Cui (si cat) prescriem ACO injectabile?

AAG = AntiAgreGante
ACO = AntiCOagulante
ACON = AntiCOagulante Non-vitamina K
 iu
f ic
n e
Be
c /
i s
R
• 1. tratamentul AAG si ACO in sindromul coronarian acut
• 2. tratamentul AAG si ACO in boala coronariana stabila
• 3. tratamentul AAG si ACO in fibrilatia atriala
• 4. tratamentul AAG si ACO in proteze valvulare mecanice
• 5. tratamentul AAG si ACO in tromboza venoasa profunda
• 6. tratamentul AAG si ACO in embolia pulmonara
• 7. atitudinea in chirurgia electiva la cei sub tratament
ACO
• 8. atitudinea in hemoragii la cei cu tratament ACO
• 9. preventia trombozei venoase profunde postoperator
 ! !
1. Sindrom Coronarian Acut
AG
a A
b l
Du
Clopidogrel vs Ticagrelor
 ! !
A G
2. BC/angina pectorala stabila

a A
b l
D u
 ! !
3. Fibrilatia atriala
AC
NO
 NOACs
• Dabigatran
– CrCl >30 mL/min: 150 mg PO 2x1/zi
– CrCl 15-30 mL/min: 75 mg PO 2x1/zi
– CrCl <15 mL/min or dialysis: No data available;
not recommended
• Apixaban: 5 mg PO 2x1/zi
• Rivaroxaban: 20 mg/zi PO with the evening meal
 ! !
4. Proteze valvulare
)
( N
mecanice

CO
A
 e ! !
st
5. Tromboza venoasa
o a
profunda

u n
e c
R
6. Embolia pulmonara
!!
1 2
1
7.Atitudine in chirurgie
E ! !
electiva
T I
EN
E V
PR
 ) !!
1
8. Managementul hemoragiilor 2
( 1
ste
o a
un
e c
 e !!
tat
9.Preventia trombozei venoase profunde
postoperator

b li i
s a
on
s p
Re
 Recommendations for patients undergoing major orthopedic surgery (total
hip arthroplasty [THA], total knee arthroplasty [TKA], or hip fracture
surgery [HFS]

• In patients underoing TKA or THA, LMWH, fondaparinux, apixaban, dabigatran, rivaroaxaban, LDUH, adjusted-dose
vitamin K antagonist (VKA), aspirin, or an IPC device for at least 10-14 days is preferable to no prophylaxis
• In patients underoing HFS, LMWH, fondaparinux, LDUH, adjusted-dose VKA, aspirin, or an IPC device for at least
10-14 days is preferable to no prophylaxis
• In patients who receive LMWH, prophylaxis should be started at least 12 hours preoperatively or postoperatively
• Thromboprophylaxis should be extended in the outpatient period for up to 35 days from the day of surgery
• In patients who are at increased risk for bleeding, an IPC device or no prophylaxis is favored over pharmacologic
prophylaxis
• In patients who refuse or will not cooperate with injections or an IPC device, apixaban or dabigatran (or, if these
are unavailable, rivaroxaban or adjusted-dose VKA) is recommended
• In patients undergoing knee arthroscopy who do not have a prior history of VTE, no thromboprophylaxis was
recommended.
 Concluzii
g! !
l o
• Evalueaza
o
i
• Incadreaza
d
ar• Trateaza
C