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Antiplatelet therapy in ENT surgery: a review
D C Sylvester1, A P Coatesworth
1Department of Otolaryngology, York Hospital, UK. dsylvester@doctors.net.uk
The Journal of Laryngology and Otology
|December 21, 2011
Summary
Prematurely stopping antiplatelet agents like aspirin and clopidogrel poses significant risks of morbidity and mortality. Multidisciplinary consultation is crucial for managing these agents during the peri-operative period, especially for ENT surgeries.
Area of Science:
- Otorhinolaryngology
- Cardiology
- Pharmacology
Background:
- Antiplatelet agents (e.g., aspirin, clopidogrel) are common in clinical practice.
- Otorhinolaryngological surgeons face decisions regarding peri-operative antiplatelet therapy.
- Balancing hemorrhage risk (continuation) versus thrombosis risk (cessation) is critical.
Purpose of the Study:
- To review literature on hemorrhage risks with antiplatelet agents.
- To evaluate morbidity and mortality associated with antiplatelet agent cessation.
- To present a management protocol for peri-operative antiplatelet agents in ENT surgery.
Main Methods:
- Literature review on spontaneous and operative hemorrhage risks.
- Evaluation of morbidity and mortality from drug cessation.
- Assessment of existing published guidelines.
- Development of a peri-operative management protocol.
Main Results:
- Significant morbidity and mortality linked to premature antiplatelet agent cessation.
- Marginal increase in operative blood loss in patients on aspirin and clopidogrel (cardiac surgery data).
Conclusions:
- Premature cessation of antiplatelet agents carries substantial risks.
- Multidisciplinary consultation is essential for peri-operative management decisions.
- A protocol for managing antiplatelet agents in ENT surgery is proposed.
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