Oral antiplatelet agents and bleeding risk in relation to major cardiovascular surgery.
BACKGROUND
Patients requiring major cardiovascular surgery are likely to be prescribed antiplatelet agents either alone or in combination. By virtue of antiplatelet agent effect, they can potentially increase bleeding complications, especially if used in combination. This article aims to review the evidence and make appropriate recommendations regarding these agents.
16 papers are reviewed which concern surgery whilst taking aspirin. The bulk of the evidence is from the coronary bypass setting. CLOPIDOGREL: 14 papers are reviewed which concern surgery whilst taking clopidogrel.
2 papers are reviewed concerning dipyridamole. CILOSTAZOL: No trials are available concerning surgery and cilostazol. Several relevant publications are reviewed.


CONCLUSIONS
It is the recommendation of the authors that aspirin should usually be continued perioperatively, whilst clopidogrel should be stopped for seven days prior to surgery if at all possible.
McCaslin
James
J
Northern Vascular Unit, Freeman Hospital, Newcastle upon Tyne, UK.
Smout
Jonathan
J
Kesteven
Patrick
P
Stansby
Gerard
G
D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use; D013504:Cardiovascular Surgical Procedures; D000077407:Cilostazol; D000077144:Clopidogrel; D004176:Dipyridamole / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology*; D012306:Risk; D013777:Tetrazoles / Q000009:adverse effects / Q000627:therapeutic use; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use
D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D004176:Dipyridamole; D000077144:Clopidogrel; D000077407:Cilostazol; D013988:Ticlopidine; D001241:Aspirin