perioperative antiplatelet therapy
Jump to navigation
Jump to search
Management
- may be continued before & after surgery for patients with high risk of thrombosis, i.e. recent coronary stent or myocardial infarction
- continue for procedures of low bleeding risk, i.e.minor dental procedures, dermatologic procedures, cataract surgery, colonoscopy
- aspirin not associated risk of bleeding in dermatologic procedures[2]
- if aspirin is held, stop 7-10 days prior to surgery
- perioperative low-dose aspirin associated with lower risk for death or nonfatal myocardial infarction vs placebo (6% vs 11%) in patients with prior PCI*
- clopidogrel
- stop clopidogrel 5 days prior to surgery[3][6]
- clopidogrel should be continued perioperatively for
- drug-eluting stent within 3 months
- bare metal stent within 30 days
- myocardial infarction or coronary revascularization within 4-6 weeks
- if possible, surgery should be delayed until clopidogrel may be stopped
- stop ticagrelor 5-7 days prior to surgery[6]
- stop prasugrel 7 days prior to surgery[6]
- for minor procedures (i.e.minor dental procedures, dermatologic procedures, cataract surgery, colonoscopy), patients receiving single antiplatelet agents should continue them perioperatively[6]
- patients receiving dual antiplatelet agent theraoy should continue aspirin & interrupt their P2Y12 inhibitor[6]
* witholding low-dose aspirin & clopidogrel may be reasonable if bleeding risk is extreme or consequences catastrophic, as with neurosurgery
Restart antiplatelet agent about 24 hours after surgery
More general terms
Additional terms
References
- ↑ Prescriber's Letter 15(8): 2008 COMMENTARY: Managing Warfarin & Antiplatelet Drugs Perioperatively GUIDELINES: ACCP Antithrombotic and Thrombolytic Guidelines, 8th edition. Executive Summary Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=240804&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 2.0 2.1 Bordeaux JS et al. Prospective evaluation of dermatologic surgery complications including patients on multiple antiplatelet and anticoagulant medications. J Am Acad Dermatol 2011 Sep; 65:576. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21782278
- ↑ 3.0 3.1 3.2 Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18, 19. American College of Physicians, Philadelphia 2012, 2015, 2018, 2022.
- ↑ Graham MM, Sessler DT, Parlow JL et al Aspirin in Patients With Previous Percutaneous Coronary Intervention Undergoing Noncardiac Surgery. Ann Intern Med. 2017. Nov 14 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29132159 <Internet> http://annals.org/aim/article-abstract/2663288/aspirin-patients-previous-percutaneous-coronary-intervention-undergoing-noncardiac-surgery
Piccolo R, Windecker S. Low-Dose Aspirin to Reduce the Risk for Myocardial Infarction Among Patients With Coronary Stents Undergoing Noncardiac Surgery. Ann Intern Med. 2017. Nov 14 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29132156 <Internet> http://annals.org/aim/article-abstract/2663289/low-dose-aspirin-reduce-risk-myocardial-infarction-among-patients-coronary - ↑ Banerjee S, Angiolillo DJ, Boden WE et al Use of Antiplatelet Therapy/DAPT for Post-PCI Patients Undergoing Noncardiac Surgery. J Am Coll Cardiol. 2017 Apr 11;69(14):1861-1870 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28385315. Free article
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 Douketis JD et al. Executive summary. Perioperative management of antithrombotic therapy: An American College of Chest Physicians clinical practice guideline. Chest 2022 Nov; 162:1127. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35964703 https://journal.chestnet.org/article/S0012-3692(22)01364-2/fulltext
Douketis JD et al. Perioperative management of antithrombotic therapy: An American College of Chest Physicians clinical practice guideline. Chest 2022 Nov; 162:e207. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35964704 https://journal.chestnet.org/article/S0012-3692(22)01359-9/fulltext