[Perioperative anti-platelet therapy management--protocol suggestion]

Currently, dual antiplatelet treatment is conducted with aspirin and clopidogrel. Preterm termination of combined treatment may cause morbidity and mortality. In patients about to undergo surgery, antiplatelet treatment is withheld before the operation to avoid perioperative excessive bleeding. As a consequence, these patients are at high perioperative thromboembolic risk.

A perioperative antiplatelet management protocol developed by a dedicated committee will be presented. This protocol guides the physician while preparing the patient for surgery through three steps: (a) What is the indication for dual antiplatelet treatment and what are the patient's thrombotic risk factors? (b) How severe is the expected operative bleeding? (c) The combination of steps (a) and (b) leads to a recommendation on whether to stop antiplatelet treatment, when and for how long, or to continue antiplatelet treatment throughout the operation. In extreme cases, the indication for antiplateLet treatment may be absolute (for example: 2 months after a drug eluting stent coronary implantation), but the expected operative bleeding is very high and the operation cannot be deferred (e.g., neurosurgery for growth removal). Such cases are referred to an expert consulting committee.

Many articles have pointed out the problems of current perioperative antiplatelet management and call for change. A precise assessment of the patient's indications, risk factors and perioperative bleeding, as guided by the suggested protocol, will result in better antiplatelet perioperative treatment, and will avoid both thromboembolic and bleeding risks.