Perioperative antiplatelet therapy: the case for continuing therapy in patients at risk of myocardial infarction

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Serval ID
serval:BIB_60F29B6C952F
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
Perioperative antiplatelet therapy: the case for continuing therapy in patients at risk of myocardial infarction
Journal
British Journal of Anaesthesia
Author(s)
Chassot  P. G., Delabays  A., Spahn  D. R.
ISSN
0007-0912 (Print)
Publication state
Published
Issued date
09/2007
Volume
99
Number
3
Pages
316-28
Notes
Journal Article
Review --- Old month value: Sep
Abstract
Recent clinical data show that the risk of coronary thrombosis after antiplatelet drugs withdrawal is much higher than that of surgical bleeding if they are continued. In secondary prevention, aspirin is a lifelong therapy and should never be stopped. Clopidogrel is regarded as mandatory until the coronary stents are fully endothelialized, which takes 3 months for bare metal stents, but up to 1 yr for drug-eluting stents. Therefore, interruption of antiplatelet therapy 10 days before surgery should be revised. After reviewing the data on the use of antiplatelet drugs in cardiology and in surgery, we propose an algorithm for the management of patients, based on the risk of myocardial ischaemia and death compared with that of bleeding, for different types of surgery. Even if large prospective studies with a high degree of evidence are still lacking on different antiplatelet regimens during non-cardiac surgery, we propose that, apart from low coronary risk situations, patients on antiplatelet drugs should continue their treatment throughout surgery, except when bleeding might occur in a closed space. A therapeutic bridge with shorter-acting antiplatelet drugs may be considered.
Keywords
Algorithms Angioplasty, Transluminal, Percutaneous Coronary/adverse effects Blood Loss, Surgical Drug Administration Schedule Humans Myocardial Infarction/etiology/*prevention & control Perioperative Care/*methods Platelet Aggregation Inhibitors/*administration & dosage/adverse effects/therapeutic use
Pubmed
Web of science
Open Access
Yes
Create date
28/01/2008 9:47
Last modification date
01/10/2019 6:18
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