Urological surgery and antiplatelet drugs after cardiac and cerebrovascular accidents.

Détails

ID Serval
serval:BIB_4608F52753D5
Type
Article: article d'un périodique ou d'un magazine.
Sous-type
Synthèse (review): revue aussi complète que possible des connaissances sur un sujet, rédigée à partir de l'analyse exhaustive des travaux publiés.
Collection
Publications
Titre
Urological surgery and antiplatelet drugs after cardiac and cerebrovascular accidents.
Périodique
Journal of Urology
Auteur(s)
Eberli Daniel, Chassot Pierre-Guy, Sulser Tullio, Samama Charles Marc, Mantz Jean, Delabays Alain, Spahn Donat R.
ISSN
1527-3792[electronic], 0022-5347[linking]
Statut éditorial
Publié
Date de publication
2010
Volume
183
Numéro
6
Pages
2128-2136
Langue
anglais
Résumé
PURPOSE: The perioperative treatment of patients on dual antiplatelet therapy after myocardial infarction, cerebrovascular event or coronary stent implantation represents an increasingly frequent issue for urologists and anesthesiologists. We assess the current scientific evidence and propose strategies concerning treatment of these patients. MATERIALS AND METHODS: A MEDLINE and PubMed search was conducted for articles related to antiplatelet therapy after myocardial infarction, coronary stents and cerebrovascular events, as well as the use of aspirin and/or clopidogrel in the context of surgery. RESULTS: Early discontinuation of antiplatelet therapy for secondary prevention is associated with a high risk of coronary thrombosis, which is further increased by the hypercoagulable state induced by surgery. Aspirin has recently been recommended as a lifelong therapy. Clopidogrel is mandatory for 6 weeks after myocardial infarction and bare metal stents, and for 12 months after drug-eluting stents. Surgery must be postponed beyond these waiting periods or performed with patients receiving dual antiplatelet therapy because withdrawal therapy increases 5 to 10 times the risk of postoperative myocardial infarction, stent thrombosis or death. The shorter the waiting period between revascularization and surgery the greater the risk of adverse cardiac events. The risk of surgical hemorrhage is increased approximately 20% by aspirin and 50% by clopidogrel. CONCLUSIONS: The risk of coronary thrombosis when antiplatelet agents are withdrawn before surgery is generally higher than the risk of surgical hemorrhage when antiplatelet agents are maintained. However, this issue has not yet been sufficiently evaluated in urological patients and in many instances during urological surgery the risk of bleeding can be dangerous. A thorough dialogue among surgeon, cardiologist and anesthesiologist is essential to determine all risk factors and define the best possible strategy for each patient.
Mots-clé
Platelet Aggregation Inhibitors, Myocardial Revascularization, Stents, Blood Loss, Surgical, Low-Dose Aspirin, Percutaneous Coronary Intervention, Ultrasound-Guided Biopsy, High-Risk Patients, Noncardiac Surgery, Transurethral Prostatectomy, Bleeding Complications, Myocardial-Infarction, Eluting Stents, Acetylsalicylic-Acid
Pubmed
Web of science
Création de la notice
31/05/2010 15:11
Dernière modification de la notice
03/03/2018 16:46
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