title: Perioperative management of antiplatelet therapy.
abstract: Worldwide, cardiovascular events represent the major cause of morbidity and mortality. A key role in the pathogenesis of these events is played by platelets. Interventional procedures, with placement of coronary and vascular stents, often represent the preferred therapeutic strategy. Antiplatelet medications are considered first-line therapy in preventing cardiovascular thrombotic events. A wide array of antiplatelet agents is available, each with different pharmacological properties. When patients on antiplatelet agents present for surgery, the perioperative team must design an optimal strategy to manage antiplatelet medications. Each patient is stratified according to risk of developing a cardiovascular thrombotic event and inherent risk of surgical bleeding. After risk stratification analysis, various therapeutic pathways include continuing or discontinuing all antiplatelet agents or maintaining one antiplatelet agent and discontinuing the other. This review focuses on the pharmacological and pharmacokinetic properties of both older and novel antiplatelet drugs, and reviews current literature and guidelines addressing options for perioperative antiplatelet management.
authors: Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA.
authors: A D
authors: AD
authors: Oprea
authors: W M
authors: WM
authors: Popescu
mesh_terms: D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use; D001777:Blood Coagulation; D003324:Coronary Artery Disease / Q000517:prevention & control; D006801:Humans; D019990:Perioperative Care; D015539:Platelet Activation; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D058921:Purinergic P2Y Receptor Antagonists / Q000627:therapeutic use; D020521:Stroke / Q000517:prevention & control
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D001241:Aspirin
keywords: antiplatelet agents; haemorrhage; perioperative period