title: Decision making after aspirin, clopidogrel and GPIIb/IIIa inhibitor use.
abstract: The expanding use of antiplatelet agents in patients who undergo coronary bypass grafting raises the problem of balancing the benefit of this treatment and the risk of increased bleeding after surgery. Aspirin and clopidogrel have different mechanisms of actions, but have in common the irreversibility of the inhibition mechanism. Even if platelets half-life is around 10 days, it is not necessary to wait for this period of time. It can be reasonable to discontinue aspirin two to three days and clopidogrel five days before surgery, even if it was recently suggested to reduce the discontinuation interval to two to three days for the clopidogrel as well. GPIIb/IIIa inhibitors have a short acting action. Reasonably, abciximab has to be stopped, when possible, at least 12 hours before surgery, preferably before 24 hours. On the contrary, tirofiban can also be stopped at the moment of skin incision without harmful effects. Very little is known of eptifibatide, but it seems that it is safe to stop it two to four hours before surgery. Patients with acute coronary syndrome do not need to discontinue any antiplatelet treatment.
authors.affiliation: Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
authors.forename: Antonio Maria
authors.initials: AM
authors.lastname: Calafiore
authors.forename: Angela Lorena
authors.initials: AL
authors.lastname: Iacò
authors.forename: Adel
authors.initials: A
authors.lastname: Tash
authors.forename: Michele Di
authors.initials: MD
authors.lastname: Mauro