Perioperative use of anti-platelet drugs.
Performing a surgical procedure on a patient undergoing anti-platelet therapy raises a dilemma: is it safer to withdraw the drugs and reduce the haemorrhagic risk, or to maintain them and reduce the risk of myocardial ischaemic events? Based on recent clinical data, this review concludes that the risk of coronary thrombosis on anti-platelet drugs withdrawal is much higher than the risk of surgical bleeding when maintaining them. In secondary prevention, aspirin is a lifelong therapy and should never be stopped. Clopidogrel is mandatory as long as the coronary stents are not fully endothelialized, which takes 6-24 weeks depending on the technique used, but might be required for a longer period.
Chassot
Pierre-Guy
PG
Department of Anoesthesiology, University Hospital Lausanne (CHUV), Bugnon 46, CH-1011 Lausanne, Switzerland. pierre-guy.chassot@chuv.ch
Delabays
Alain
A
Spahn
Donat R
DR
D001241:Aspirin / Q000627:therapeutic use; D000077144:Clopidogrel; D003328:Coronary Thrombosis / Q000517:prevention & control*; D017558:Elective Surgical Procedures; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D019990:Perioperative Care; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D015607:Stents; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin