Antiplatelet therapy in the perioperative period

Area of Science:

• Cardiology
• Pharmacology
• Vascular Medicine

Background:

• Antiplatelet drugs are crucial for preventing arterial thrombosis.
• Historically, antiplatelet therapy was interrupted perioperatively due to bleeding concerns.
• Recent evidence challenges the routine discontinuation of antiplatelet therapy before procedures.

Purpose of the Study:

• To evaluate the current recommendations regarding perioperative antiplatelet drug management.
• To assess the balance between bleeding risk and atherothrombotic events when managing antiplatelet therapy around surgery.
• To provide guidance on continuing or discontinuing antiplatelet drugs in patients undergoing procedures.

Main Methods:

• Review of current guidelines and clinical evidence on perioperative antiplatelet therapy.
• Risk-benefit analysis of continuing versus discontinuing low-dose aspirin (LD ASA) and thienopyridines.
• Case-by-case consideration of bleeding versus atherothrombotic complications.

Main Results:

• Recent guidelines no longer advocate for routine interruption of LD ASA in high-risk patients.
• The decision to continue or stop LD ASA should be individualized based on bleeding and atherothrombotic risk.
• Thienopyridines carry a higher bleeding risk than LD ASA and should generally be stopped one week before surgery, except in specific cases.

Conclusions:

• Perioperative management of antiplatelet therapy requires careful consideration of individual patient risk factors.
• Routine discontinuation of LD ASA is not recommended for high-risk patients undergoing surgery.
• Thienopyridine use requires specific management strategies, particularly concerning recent coronary stenting.