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The efficacy and safety of perioperative antiplatelet therapy
J Christopher Merritt1, Deepak L Bhatt
1Cleveland Clinic Foundation, 9500 Euclid Ave., Desk F25, Cleveland, Ohio 44195, USA.
Insights
Antiplatelet agents like aspirin and clopidogrel are crucial for cardiovascular patients. This review examines their safe and effective perioperative use, aiding surgical decisions for patients on these therapies.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Surgical Management
Background:
- Antiplatelet agents significantly reduce major adverse cardiovascular events in various cardiovascular conditions.
- A growing number of patients on antiplatelet therapy require surgical procedures, necessitating perioperative management strategies.
- Understanding the risks and benefits of antiplatelet drugs during the perioperative period is increasingly important.
Purpose of the Study:
- To review the perioperative safety and efficacy of commonly used antiplatelet agents.
- To provide guidance for clinicians managing antiplatelet therapy around cardiac and noncardiac surgeries.
Main Methods:
- Review of available data on the perioperative use of aspirin, clopidogrel, and glycoprotein (GP) IIb/IIIa inhibitors (abciximab, eptifibatide, tirofiban).
- Examination of evidence regarding the safety and efficacy of these agents in surgical settings.
- Consideration of emerging platelet monitoring techniques.
Main Results:
- Data suggest that antiplatelet agents can be used safely prior to surgery when managed appropriately.
- Evidence supports the efficacy of these agents in improving surgical outcomes and preventing postoperative cardiovascular events.
- The review consolidates information on specific agents, including aspirin, clopidogrel, and GP IIb/IIIa inhibitors.
Conclusions:
- Appropriate perioperative management of antiplatelet therapy is feasible and beneficial.
- This information, combined with platelet monitoring, can assist clinicians in timing surgeries for patients on antiplatelet agents.
- Safe and effective use of antiplatelet agents perioperatively is achievable, balancing cardiovascular protection with surgical considerations.
Abstract:
Widespread adoption of the antiplatelet agents into everyday clinical practice has revolutionized contemporary care of the cardiovascular patient. Major adverse cardiovascular events including death, myocardial infarction, stroke, and recurrent angina have all been shown to be significantly decreased when these agents are employed in the treatment of coronary atherosclerosis, acute coronary syndromes, myocardial infarction, and in the setting of percutaneous coronary intervention. As a growing number of patients on antiplatelet therapy are undergoing various surgical procedures, the potential risks and benefits these drugs pose perioperatively will become increasingly important. Available data indicate that, when used appropriately, these drugs can be used safely prior to surgery. Efficacy in improving surgical outcomes and in preventing adverse cardiovascular events postoperatively has also been demonstrated. The purpose of this review is to examine the perioperative safety and efficacy of the most widely used antiplatelet agents: aspirin; the thienopyridine clopidogrel; and the glycoprotein (GP) IIb/IIIa inhibitors abciximab, eptifibatide, and tirofiban. This information, coupled with emerging platelet monitoring techniques, may help provide additional assistance to the clinician to manage therapy and guide appropriate timing of both cardiac and noncardiac surgery.