芸香 = 橘子

最近2週來，美國心臟科和腸胃科協會陸續發表對aspirin或是其他抗凝血劑的文章

內容針對手術前這類藥品究竟要不要停藥，之前的舊觀念認為至少停藥5～14天(依藥品而異)，以防止手術中血液不正常出血！

但這2周文章則修改先前觀念，

(1) 單純只是做預防用的病人，例如高血脂.高血壓...，則於手術前建議停藥

(2) 特殊病人，例如 已作心臟支架而使用抗凝血劑者(plavix + aspirin)，.

但使用clopidogrel (Plavix)者，仍然是多數外科手術醫生所擔心的！(drug-eluting time很長)
重大手術(polypectomy, sphincterotomy, pneumatic dilation, PEG [percutaneous endoscopic gastrostomy])，醫生通常會要求停藥6個月(單然是指病人可以忍受，且已經於3個月前和自己的心臟科醫師討論過後)，但是仍然需要背負著高風險的新臟支架發生血栓凝集！(study已經證實   如：使用plavix的人停藥1個月，約有30%的人心支架栓塞)，建議上最好是再用1個月在停藥，且aspirin是絕對不可以停藥！如果有替代方案，外科醫生會盡量針對此類病人作修改，畢竟停藥的風險太大。

原文：Stent thrombosis can occur in approximately 30% of those patients within a month of stopping the clopidogrel. For a bare metal stent, the recommendation is that you've got to continue the clopidogrel for 30 days, and after that it probably doesn't need to be kept on board. [Patients] continue on aspirin. For drug-eluting stents, the data are strong for 6 months and probably a lot longer than that. You can negotiate with your cardiologist to stop at the end of 6 months for elective procedures. Remember that the cardinal rule is you need to stay on aspirin.

有醫生提出是否可以暫時改用low-molecular-weight heparin (drug-eluting time 相對較短)，2者效果相比，並無法取代plavix在新知架的保護效果，無法以取代方式替代！

The evidence says that antiplatelet agents really do have a significant benefit. Stent thrombosis acutely carries with it a 50% myocardial infarct rate and a 20% death rate within 30 days.