[Antiplatelet drugs - implications for the anesthesiologist].

Area of Science:

• Cardiology
• Pharmacology
• Interventional Cardiology

Context:

• Aspirin and thienopyridines are crucial for inhibiting platelet aggregation in acute coronary syndromes and post-coronary stenting.
• Dual antiplatelet therapy (DAPT) duration varies: 3 months for bare-metal stents and ≥12 months for drug-eluting stents, reducing stent thrombosis.
• Patients on DAPT may require urgent surgery, necessitating a risk-benefit assessment for perioperative management.

Purpose:

• To evaluate the management of patients requiring surgery while on dual antiplatelet therapy after coronary stenting.
• To analyze the risks of major surgical bleeding versus major cardiovascular events during perioperative aspirin continuation.
• To provide guidance on managing bleeding complications during DAPT.

Summary:

• Elective surgery is contraindicated during DAPT post-stenting due to thrombosis risk.
• Urgent surgical indications require a risk-benefit analysis comparing surgical bleeding with cardiovascular events if aspirin is continued.
• Platelet function tests are not recommended for guiding perioperative antiplatelet therapy.
• Major bleeding during DAPT should be managed with antifibrinolytics (e.g., tranexamic acid) and platelet transfusions.

Impact:

• Informs clinical decision-making for perioperative management of patients on dual antiplatelet therapy.
• Highlights the importance of individualized risk assessment in complex surgical cases.
• Provides evidence-based recommendations for managing bleeding complications in this high-risk patient population.