Antiplatelet drugs : is there a surgical risk?
Acetylsalicylic acid has long been the only nonsteroidal anti-inflammatory drug recommended for the treatment and prevention of thromboembolic diseases. More recently, new compounds have been used in patients with vascular diseases. However, these drugs are often associated with longer bleeding times and greater operative risk. In most surgical specialties, the question always arises as to whether antiplatelet therapy should be stopped before elective surgery. If so, for how long? If not, what are the risks? This article reviews the various antiplatelet drugs in use today, focusing on their mode of action, their effects on platelet function and the associated operative risks. It also proposes an algorithm for decision making in this setting, based on the literature and an understanding of the mechanisms of action of this class of drugs.
Daniel
Nach G
NG
Department of Oral and Maxillofacial Surgery, Hospital Centre/Hôpital de l'Enfant-Jésus, Laval University, Sainte Foy, Quebec, Canada. nachdaniel@hotmail.com
Goulet
Jacques
J
Bergeron
Marc
M
Paquin
Robert
R
Landry
Pierre-Eric
PE
D001241:Aspirin / Q000494:pharmacology; D001778:Blood Coagulation Disorders / Q000188:drug therapy*; D016063:Blood Loss, Surgical; D016861:Cyclooxygenase Inhibitors / Q000494:pharmacology; D003663:Decision Trees; D017742:Dental Care for Chronically Ill; D006801:Humans; D010726:Phosphodiesterase Inhibitors / Q000494:pharmacology; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D019106:Postoperative Hemorrhage / Q000209:etiology; D058919:Purinergic P2 Receptor Antagonists; D012307:Risk Factors
D016861:Cyclooxygenase Inhibitors; D010726:Phosphodiesterase Inhibitors; D010975:Platelet Aggregation Inhibitors; D058919:Purinergic P2 Receptor Antagonists; D001241:Aspirin