机构：[1]Department of Orthopaedics, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China临床科室骨科首都医科大学附属安贞医院[2]Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China外科系统(本部)骨科（本部）北京朝阳医院[3]Department of Orthopaedics, No. 2 Clinical Hospital of Hunan University of Medicine, Huaihua, Hunan 418000, China.
Background: To prevent risk of life-threatening stent thrombosis, all patients need to undergo dual antiplatelet therapy (DAPT) for at least 6 weeks to 12 months after stent implantation. If DAPT is continued during noncardiac surgery, there is a risk of severe bleeding at the surgical site. Our study was to assess the risk of bleeding in patients with continued DAPT during orthopedic surgery. Methods: The clinical data of 78 patients with coronary heart disease who underwent orthopedic surgery from February 2006 to July 2018 were retrospectively analyzed. Prior to orthopedic surgery, DAPT was continued in 16 patients (group I), 24 patients were treated with single antiplatelet therapy (group II), and 26 patients received low-molecular-weight heparin therapy for more than 5 days after the discontinuation of all antiplatelet therapies (group III). Twelve patientswere excluded, as they had undergone minimally invasive surgery such as transforaminal endoscopy and vertebroplasty. The perioperative blood loss of each patient was calculated usingNadler's formula and Gross' formula. The intraoperative bleeding volume, total volume of intraoperative bleeding in addition to postoperative drainage, and total blood loss were compared between groups. The level of significance was set at P < 0.05. Results: There were no significant differences between the three groups in age, intraoperative bleeding volume, total volume of intraoperative bleeding in addition to postoperative drainage, and total perioperative blood loss calculated by Nadler's formula and Gross' formula (all P > 0.05). Six patients experienced postoperative cardiovascular complications due to the delayed restart of antiplatelet therapy; one of these patients in group III died from myocardial infarction. Conclusions: Continued DAPT or single antiplatelet treatment during orthopedic surgery does not increase the total intraoperative and perioperative bleeding compared with switching from antiplatelet therapy to low-molecular-weight heparin. However, the discontinuation of antiplatelet therapy increases the risk of serious cardiac complications.
第一作者机构：[1]Department of Orthopaedics, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China[2]Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
通讯作者：
通讯机构：[2]Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China[*1]Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
推荐引用方式(GB/T 7714)：
San-Bao Hu,Yong Hai,Jie-Fu Tang,et al.Risk of bleeding in patients with continued dual antiplatelet therapy during orthopedic surgery[J].CHINESE MEDICAL JOURNAL.2019,132(8):943-947.doi:10.1097/CM9.0000000000000186.
APA：
San-Bao Hu,Yong Hai,Jie-Fu Tang,Tao Liu,Bing-Xin Liang&Bo-Qiong Xue.(2019).Risk of bleeding in patients with continued dual antiplatelet therapy during orthopedic surgery.CHINESE MEDICAL JOURNAL,132,(8)
MLA：
San-Bao Hu,et al."Risk of bleeding in patients with continued dual antiplatelet therapy during orthopedic surgery".CHINESE MEDICAL JOURNAL 132..8(2019):943-947
