title: Antiplatelet therapy in ENT surgery: a review.
abstract: BACKGROUND
  Antiplatelet agents such as aspirin and clopidogrel are increasingly encountered in clinical practice. Otorhinolaryngological surgeons are involved in the peri-operative decision of whether to continue treatment and risk haemorrhage or to discontinue treatment and risk thrombosis.
  
  
  METHODS
  Literature relating to the risk of spontaneous or operative haemorrhage was reviewed. The morbidity and mortality associated with cessation of agents was evaluated. Published guidelines were also evaluated. A protocol for the management of antiplatelet agents in the peri-operative period, with particular reference to ENT operations, is presented.
  
  
  CONCLUSIONS
  SIGNIFICANT morbidity and mortality is associated with the premature cessation of antiplatelet agents. Data from cardiac surgery suggest that operative blood loss only marginally increases in patients on aspirin and clopidogrel. However, the management of antiplatelet agents in the peri-operative period should be made after multidisciplinary consultation.
authors.affiliation: Department of Otolaryngology, York Hospital, UK. dsylvester@doctors.net.uk
authors.forename: D C
authors.initials: DC
authors.lastname: Sylvester
authors.forename: A P
authors.initials: AP
authors.lastname: Coatesworth
mesh_terms: D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D016063:Blood Loss, Surgical / Q000517:prevention & control / Q000706:statistics & numerical data*; D000077144:Clopidogrel; D003657:Decision Making; D054855:Drug-Eluting Stents; D006801:Humans; D013517:Otorhinolaryngologic Surgical Procedures; D019990:Perioperative Care / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D012307:Risk Factors; D013927:Thrombosis / Q000517:prevention & control; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000494:pharmacology
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin