Perioperative management of antiplatelet agents in noncardiac surgery.
It is common that patients who are scheduled for surgery are treated with antiplatelet agents (APAs) due to their wide indications. The management of these APAs in the perioperative period (acetylsalicylic acid alone, a thienopyridine alone or, in most cases, a combination of them) has a dual perspective: the risk of bleeding when the patient is operated under the effect of the APA against the risk of thrombosis if it has been withdrawn. The main challenges for the anaesthesiologist and the surgeon include patients with a coronary stent (mainly, new drug-eluting coronary stents), those undergoing urgent surgery and those undergoing high bleeding risk surgery. We review current protocols and discuss the most recent proposals for the management of APAs in patients undergoing noncardiac surgery. Current recommendations include the maintenance of aspirin if possible throughout the perioperative period, in order to limit the risks of cardiological, vascular or neurological postoperative events, although this makes it necessary to assume a small risk for haemorrhagic complications in some patients. Nevertheless, there are many circumstances that are not clear yet and, in this situation, it is crucial that patients are treated with a multidisciplinary approach (anaesthesiologists, surgeons, cardiologists and haematologists).
Llau
Juan V
JV
Department of Anaesthesiology and Critical Care Medicine, University Clinic Hospital, Valencia, Spain. juanvllau@gmail.com
Lopez-Forte
Cristina
C
Sapena
Luisa
L
Ferrandis
Raquel
R
D006321:Heart; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology*; D011300:Preoperative Care; D012307:Risk Factors; D013514:Surgical Procedures, Operative; D013927:Thrombosis / Q000517:prevention & control
D010975:Platelet Aggregation Inhibitors