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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
10:28

Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function

Published on: March 15, 2022

[Antiplatelet drugs and intraoperative hemorrhage]

Pierres Guy Chassot1, Alain Delabays, Patrick Ravussin

  • 1Département de cardiologie CHUV, 1011 Lausanne. pchassot@chuv.ch

Revue Medicale Suisse
|February 3, 2007
PubMed

Insights

Maintaining antiplatelet therapy poses less risk than stopping it, which can dangerously increase coronary thrombosis. Aspirin and clopidogrel should generally continue, except in high-risk intracranial surgery, to prevent perioperative thrombosis.

Area of Science:

  • Cardiology
  • Pharmacology
  • Surgical Medicine

Background:

  • Antiplatelet drugs are crucial for preventing thrombotic events.
  • Perioperative management of antiplatelet therapy presents a complex clinical challenge.
  • Balancing bleeding risk against thrombotic risk is essential.

Purpose of the Study:

  • To review the current literature on the risks associated with interrupting antiplatelet therapy during surgery.
  • To provide guidance on the perioperative management of aspirin and clopidogrel.
  • To assess the risks of coronary thrombosis versus intraoperative hemorrhage.

Main Methods:

  • Literature review of studies on antiplatelet drugs and surgical bleeding/thrombosis.
  • Analysis of clinical evidence regarding aspirin and clopidogrel continuation versus interruption.
  • Evaluation of specific surgical contexts, such as intracranial surgery.

Main Results:

  • Maintaining antiplatelet therapy is associated with lower risks than interruption.
  • Stopping antiplatelet therapy significantly increases the danger of coronary thrombosis.
  • Aspirin should not be interrupted for secondary prevention.
  • Clopidogrel should be continued unless there is a high risk of hemorrhage in closed cavities.

Conclusions:

  • Continuing antiplatelet therapy, including aspirin and clopidogrel, is generally safer than interruption.
  • The risk of coronary thrombosis outweighs bleeding risks in most surgical scenarios.
  • Exceptions for clopidogrel interruption are limited to specific high-risk situations like intracranial surgery.

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