{"id":4783,"date":"2018-11-02T22:16:51","date_gmt":"2018-11-02T22:16:51","guid":{"rendered":"https:\/\/www.cgs-cls.cz\/?page_id=4783"},"modified":"2022-11-17T10:10:30","modified_gmt":"2022-11-17T09:10:30","slug":"antitromboticka-terapie-a-endoskopicky-vykon","status":"publish","type":"page","link":"https:\/\/www.cgs-cls.cz\/antitromboticka-terapie-a-endoskopicky-vykon\/","title":{"rendered":"Antitrombotick\u00e1 terapie a endoskopick\u00fd v\u00fdkon"},"content":{"rendered":"
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\n\n\n\n\n\n\n\n\n\n
terapie<\/td>\nRiziko procedury (najet kurzorem)<\/em><\/small><\/a><\/td>\n<\/th>\n<\/tr>\n
n\u00edzk\u00e9<\/strong><\/span><\/td>\nvysok\u00e9<\/strong><\/span><\/td>\n<\/td>\n<\/tr>\n
ASA<\/td>\npokra\u010dovat<\/td>\npokra\u010dovat<\/strong>1<\/sup><\/td>\n<\/td>\n<\/tr>\n
P2Y12<\/sub> i
\n(DAPT)<\/td>\n		pokra\u010dovat
\n(plat\u00ed pro monoterapii i DAPT)<\/td>\n		vysadit 7 dn\u00ed<\/strong>
\n(ponechat ASA v p\u0159\u00edpad\u011b DAPT)<\/td>\n		RIZIKOV\u00dd PACIENT<\/a><\/td>\n<\/tr>\n
warfarin<\/td>\npokra\u010dovat
\n(ov\u011b\u0159it v t\u00fddnu p\u0159ed v\u00fdkonem INR <3)<\/strong><\/td>\n		vysadit 5 dn\u00ed<\/strong>2<\/sup>
\n(ov\u011b\u0159it den p\u0159ed v\u00fdkonem INR <1,5)<\/td>\n		P\u0158EMOST\u011aN\u00cd\u00a0(BRIDGING)<\/a><\/td>\n<\/tr>\n
LMWH<\/td>\npokra\u010dovat<\/td>\nbridging: za\u010d\u00edt 2 dny po vysazen\u00ed warfarinu
\nvysadit 24 h p\u0159ed v\u00fdkonem<\/strong>3<\/sup><\/td>\n		POZOR\u00a0ren\u00e1ln\u00ed funkce!<\/a><\/td>\n<\/tr>\n
DOAC<\/td>\nvynechat rann\u00ed d\u00e1vku<\/strong><\/td>\nvysadit 2 dny <\/strong>(bridging<\/del>)4<\/sup><\/td>\np\u0159emost\u011bn\u00ed\u00a0nen\u00ed indikov\u00e1no<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<\/div>\n
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V\u017dDY INDIVIDU\u00c1LN\u011a V\u00c1\u017dIT RIZIKA U KONR\u00c9TN\u00cdHO PACIENTA, NEJL\u00c9PE VE SPOLUPR\u00c1CI S L\u00c9KA\u0158EM INDIKUJ\u00cdC\u00cdM ANTITROMBOTICKOU TERAPII.
\nV\u017dDY ZV\u00c1\u017dIT ODLO\u017dEN\u00cd ELEKTIVN\u00cd PROCEDURY U PACIENTA S DO\u010cASNOU ANTITROMBOTICKOU TERAPI\u00cd.
\n1<\/sup>p\u0159edpokl\u00e1dan\u00e1 indikace sekund\u00e1rn\u00ed prevence; vysazen\u00ed zv\u00e1\u017eit jen na \u017e\u00e1dost endoskopisty 7 dn\u00ed p\u0159ed v\u00fdkony s velmi vysok\u00fdm rizikem nap\u0159. ampulektomie; EMR\/ESD s velmi vysok\u00fdm rizikem (horn\u00ed GIT a rozs\u00e1hl\u00e9)
\n2<\/sup>d\u00e9le u nemocn\u00fdch s vy\u0161\u0161\u00edm c\u00edlov\u00fdm INR, s velmi n\u00edzkou d\u00e1vkou warfarinu a vysok\u00e9ho v\u011bku s komorbiditami
\n3<\/sup>zv\u00e1\u017eit prodlou\u017een\u00ed intervalu u LMWH ur\u010den\u00e9ho k pod\u00e1v\u00e1n\u00ed jednou denn\u011b (FORTE)
\n4<\/sup>dabigatran p\u0159i GF 30-50 ml\/min vysadit 4 dny<\/div>\n

Literatura: Veitch AM et al. Endoscopy in patients on antiplatelet or anticoagulant therapy: BSG and ESGE guideline update. Endoscopy 2021;53:947-69.
\nZp\u011btn\u00e1 vazba: jiri.cyrany@fnhk.cz<\/a><\/em><\/p>\n

Seznam zkratek: ASA - acetylsalicylov\u00e1 kyselina; P2Y12<\/sub>i - inhibitor receptoru P2Y12<\/sub> (clopidogrel, prasugrel, ticagrelor); DAPT - du\u00e1ln\u00ed protidesti\u010dkov\u00e1 terapie; DOAC - p\u0159\u00edm\u00e1 or\u00e1ln\u00ed antikoagulancia (apixaban, edoxaban, rivaroxaban, dabigatran); GF - glomerul\u00e1rn\u00ed filtrace; INR - international normalized ratio; LMWH - n\u00edzkomolekul\u00e1rn\u00ed heparin; GIT - gastrointestin\u00e1ln\u00ed trakt<\/em><\/small><\/p>\n<\/div>\n

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\n\n\n\n\n\n\n\n\n\n\n
Pod\u00e1v\u00e1n\u00ed antitrombotick\u00e9 terapie p\u0159ed a po endoskopick\u00e9m v\u00fdkonu s vysok\u00fdm rizikem krv\u00e1cen\u00ed<\/strong><\/td>\n<\/tr>\n
datum<\/strong><\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
den<\/td>\n-8<\/td>\n-7<\/td>\n-6<\/td>\n-5<\/td>\n-4<\/td>\n-3<\/td>\n-2<\/td>\n-1<\/td>\n0<\/td>\n+1<\/td>\n+2<\/td>\n+3<\/td>\n+4<\/td>\n+5<\/td>\n+6<\/td>\n<\/tr>\n
ASA<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
P2Y12<\/sub>i<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\nden v\u00fdkonu<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
warfarin<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\nINR<\/strong><\/em><\/td>\n1<\/td>\n<\/td>\n<\/td>\n<\/td>\nINR<\/strong><\/em><\/td>\n<\/td>\n<\/tr>\n
LMWH<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n2<\/td>\n<\/td>\n<\/td>\n3<\/td>\n<\/td>\n<\/td>\n<\/td>\n4<\/td>\n<\/td>\n<\/tr>\n
DOAC<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n5<\/td>\n<\/td>\n<\/td>\n6<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<\/div>\n
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POSTUP PO ENDOSKOPICK\u00c9M V\u00ddKONU UR\u010cUJE ENDOSKOPISTA INDIVIDU\u00c1LN\u011a VE SPOLUPR\u00c1CI S ODBORNOST\u00cd INDIKUJ\u00cdC\u00cd ANTITROMBOTIKUM.
\nTERAPEUTICK\u00c9 \u00daROVN\u011a ANTIKOAGULACE BY NEM\u011aLO B\u00ddT DOSA\u017dENO D\u0158\u00cdVE NE\u017d ZA 48 HODIN.
\n1<\/sup>warfarin v udr\u017eovac\u00ed (nikoli satura\u010dn\u00ed) d\u00e1vce
\n2<\/sup>LMWH p\u0159emost\u011bn\u00ed warfarinu pouze v p\u0159\u00edpad\u011b vysok\u00e9ho tromboembolick\u00e9ho rizika
\n3<\/sup>terapeutick\u00e1 d\u00e1vka LMWH ne d\u0159\u00edve ne\u017e za 48 h, d\u0159\u00edve mo\u017eno pod\u00e1vat ni\u017e\u0161\u00ed d\u00e1vku
\n4<\/sup>LMWH pod\u00e1vat do \u00fa\u010dinn\u00e9ho INR
\n5<\/sup>dabigatran p\u0159i GF 30-50 ml\/min vysadit 4 dny
\n6<\/sup>u vybran\u00fdch pacient\u016f s vysok\u00fdm trombotick\u00fdm rizikem mo\u017eno b\u011bhem prvn\u00edch 48 hodin pou\u017e\u00edt n\u00edzk\u00e9 d\u00e1vky LMWH<\/div>\n

Literatura: Douketis JD et al. Perioperative management of antithrombotic therapy: an American College of Chest Physicians clinical practice guideline executive summary. Chest 2022;162:E207-E243.
\nZp\u011btn\u00e1 vazba: jiri.cyrany@fnhk.cz<\/a><\/em><\/p>\n

Seznam zkratek: ASA - acetylsalicylov\u00e1 kyselina; P2Y12<\/sub>i - inhibitor receptoru P2Y12<\/sub> (clopidogrel, prasugrel, ticagrelor); INR - international normalized ratio; LMWH - n\u00edzkomolekul\u00e1rn\u00ed heparin; DOAC - p\u0159\u00edm\u00e1 or\u00e1ln\u00ed antikoagulancia (apixaban, edoxaban, rivaroxaban, dabigatran)<\/em><\/small><\/p>\n<\/div>\n

Tabulka k tisku A4<\/strong><\/a>  Vzor - jak vyplnit tabulku?<\/strong><\/a><\/p>\n