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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
PubMed

Insights

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.
Abstract

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