{"id":4796,"date":"2018-11-02T22:43:22","date_gmt":"2018-11-02T22:43:22","guid":{"rendered":"https:\/\/www.cgs-cls.cz\/?page_id=4796"},"modified":"2022-11-16T13:52:19","modified_gmt":"2022-11-16T12:52:19","slug":"premosteni","status":"publish","type":"page","link":"https:\/\/www.cgs-cls.cz\/antitromboticka-terapie-a-endoskopicky-vykon\/premosteni\/","title":{"rendered":"P\u0159emost\u011bn\u00ed"},"content":{"rendered":"
P\u0159emost\u011bn\u00ed (bridging) p\u0159i vysazen\u00ed warfarinu pomoc\u00ed n\u00edzkomolekul\u00e1rn\u00edho heparinu.<\/strong>
\nP\u0159emost\u011bn\u00ed (bridging) p\u0159i vysazen\u00ed warfarinu (nikoliv DOAC) pomoc\u00ed LMWH je indikov\u00e1no dle tromboembolick\u00e9ho rizika.
\n(indikov\u00e1no u vysok\u00e9ho a neindikov\u00e1no u n\u00edzk\u00e9ho rizika, k individu\u00e1ln\u00edmu zv\u00e1\u017een\u00ed u st\u0159edn\u00edho rizika)<\/div>\n
\n
\n
\n\n\n\n\n\n\n\n
indikace k antikoagulaci<\/th>\nTromboembolick\u00e9 riziko antikoagulovan\u00fdch pacient\u016f<\/th>\n<\/tr>\n
vysok\u00e9<\/td>\nst\u0159edn\u00ed<\/td>\nn\u00edzk\u00e9<\/td>\n<\/tr>\n
mechanick\u00e1 chlopenn\u00ed n\u00e1hrada<\/strong><\/td>\nmitr\u00e1ln\u00ed
\naort\u00e1ln\u00ed (jin\u00e1 ne\u017e dvoulist\u00e1)
\n+ CMP nebo TIA p\u0159ed <3 m\u011bs\u00edci<\/td>\n		aort\u00e1ln\u00ed dvoulist\u00e1
\ns nejm\u00e9n\u011b jedn\u00edm rizikov\u00fdm faktorem1<\/sup><\/td>\n		aort\u00e1ln\u00ed dvoulist\u00e1
\nbez fibrilace s\u00edn\u00ed nebo jin\u00e9ho rizika1<\/sup>
\n(jak\u00e1koliv bioprot\u00e9za – xenograft)<\/td>\n<\/tr>\n
fibrilace s\u00edn\u00ed<\/strong><\/td>\nCHA2<\/sub>DS2<\/sub>VASc \u22657<\/strong>
\n(ro\u010dn\u00ed riziko iktu >10%)<\/em>
\n+ CMP nebo TIA p\u0159ed <3 m\u011bs\u00edci
\n+ revmatick\u00e1 chlopenn\u00ed vada
\n+ mitr\u00e1ln\u00ed sten\u00f3za<\/td>\n		CHA2<\/sub>DS2<\/sub>VASc 5-6<\/strong>
\n(ro\u010dn\u00ed riziko iktu 5-10%)<\/em><\/td>\n		CHA2<\/sub>DS2<\/sub>VASc 1-4<\/strong>
\n(ro\u010dn\u00ed riziko iktu <5%)<\/em><\/td>\n<\/tr>\n
\u017eiln\u00ed tromboembolismus<\/strong><\/td>\nVTE <3 m\u011bs\u00edc\u016f
\nt\u011b\u017ek\u00e1 trombofilie2<\/sup>
\nVTE p\u0159i vysazen\u00ed warfarinu
\naktivn\u00ed malignita s vysok\u00fdm rizikem4<\/sup><\/td>\n		VTE p\u0159ed 3-12 m\u011bs\u00edci
\ntrombofilie jin\u00e1 ne\u017e t\u011b\u017ek\u00e13<\/sup>
\nrecidivuj\u00edc\u00ed VTE
\naktivn\u00ed malignita5<\/sup><\/td>\n		VTE p\u0159ed >12 m\u011bs\u00edci
\nbez jin\u00fdch rizikov\u00fdch faktor\u016f<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<\/div>\n
\n
1<\/sup>fibrilace s\u00edn\u00ed, anamn\u00e9za CMP nebo TIA, arteri\u00e1ln\u00ed hypertenze, diabetes mellitus, m\u011bstnav\u00e9 srde\u010dn\u00ed selh\u00e1n\u00ed, v\u011bk >75 let
\n2<\/sup>nap\u0159. deficit proteinu C, proteinu S nebo antitrombinu, homozygot mutace faktoru V Leiden nebo mutace protrombinov\u00e9ho genu nebo sm\u00ed\u0161en\u00fd heterozygot t\u011bchto mutac\u00ed, antifosfolipidov\u00fd syndrom, mnoho\u010detn\u00e9 abnormality
\n3<\/sup>nap\u0159. heterozygot mutace faktoru V Leiden nebo protrombinu
\n4<\/sup>karcinom j\u00edcnu, \u017ealudku, pankreatu, myeloproliferativn\u00ed onemocn\u011bn\u00ed a prim\u00e1rn\u00ed mozkov\u00fd n\u00e1dor
\n5<\/sup>l\u00e9\u010dba v posledn\u00edch 6 m\u011bs\u00edc\u00edch nebo paliativn\u00ed p\u00e9\u010de (zvl\u00e1\u0161t\u011b b\u011bhem aktivn\u00ed l\u00e9\u010dby a p\u0159i metastatick\u00e9m posti\u017een\u00ed)<\/div>\n

Literatura: Abraham NS et al. ACG-CAG clinical practice guideline: management of anticoagulants and antiplatelets during acute gastrointestinal bleeding and the periendoscopic period. Am J Gastroenterol 2022;117:542-558.
\nZp\u011btn\u00e1 vazba: jiri.cyrany@fnhk.cz<\/a><\/em><\/p>\n

Seznam zkratek: LMWH – n\u00edzkomolekul\u00e1rn\u00ed heparin; DOAC – p\u0159\u00edm\u00e9 or\u00e1ln\u00ed antikoagulans; CMP – c\u00e9vn\u00ed mozkov\u00e1 p\u0159\u00edhoda; TIA – tranzitorn\u00ed ischemick\u00e1 ataka; CHA2DS2VASc – sk\u00f3re rizika iktu p\u0159i fibrilaci s\u00edn\u00ed; VTE – ven\u00f3zn\u00ed tromboembolismus (\u017eiln\u00ed tromb\u00f3za a\/nebo plicn\u00ed embolie)<\/em><\/small><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

P\u0159emost\u011bn\u00ed (bridging) p\u0159i vysazen\u00ed warfarinu pomoc\u00ed n\u00edzkomolekul\u00e1rn\u00edho heparinu. P\u0159emost\u011bn\u00ed (bridging) p\u0159i vysazen\u00ed warfarinu (nikoliv DOAC) pomoc\u00ed LMWH je indikov\u00e1no dle tromboembolick\u00e9ho rizika. (indikov\u00e1no u vysok\u00e9ho a neindikov\u00e1no u n\u00edzk\u00e9ho rizika, k individu\u00e1ln\u00edmu zv\u00e1\u017een\u00ed u st\u0159edn\u00edho rizika) indikace k antikoagulaci Tromboembolick\u00e9 riziko antikoagulovan\u00fdch pacient\u016f vysok\u00e9 st\u0159edn\u00ed n\u00edzk\u00e9 mechanick\u00e1 chlopenn\u00ed n\u00e1hrada mitr\u00e1ln\u00ed aort\u00e1ln\u00ed (jin\u00e1 ne\u017e dvoulist\u00e1) + CMP nebo […]<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":4783,"menu_order":1,"ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-4796","page","type-page","status-publish","hentry"],"acf":[],"lang":"cs","translations":{"cs":4796},"pll_sync_post":[],"_links":{"self":[{"href":"https:\/\/www.cgs-cls.cz\/api\/wp\/v2\/pages\/4796","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.cgs-cls.cz\/api\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.cgs-cls.cz\/api\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.cgs-cls.cz\/api\/wp\/v2\/users\/1"}],"version-history":[{"count":20,"href":"https:\/\/www.cgs-cls.cz\/api\/wp\/v2\/pages\/4796\/revisions"}],"predecessor-version":[{"id":7437,"href":"https:\/\/www.cgs-cls.cz\/api\/wp\/v2\/pages\/4796\/revisions\/7437"}],"up":[{"embeddable":true,"href":"https:\/\/www.cgs-cls.cz\/api\/wp\/v2\/pages\/4783"}],"wp:attachment":[{"href":"https:\/\/www.cgs-cls.cz\/api\/wp\/v2\/media?parent=4796"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}