[Antiplatelet drugs - implications for the anesthesiologist]

Aspirin and thienopyridines are the mainstay of platelet aggregation inhibition in patients with acute coronary syndromes and patients receiving coronary artery stents. After elective coronary artery stenting, they are prescribed for up to 3 months after bare metall stents and for at least 12 months after drug-eluting stents, thereby significantly reducing the risk of acute stent thrombosis. During this time period, patients should not undergo elective surgery. However, they may present with surgically amenable diseases that do not allow further delay. In these cases a careful risk-benefit analysis is required to elucidate the risk of major surgical bleeding versus the risk of major cardiovascular events with aspirin to be continued throughout the perioperative period. Current evidence does not suggest to use platelet function tests to guide therapy under these circumstances. If major bleeding occurs under dual platelet aggregation inhibition, the most appropriate interventions are antifibrinolytics such as tranexamic acid and transfusion of platelets to counteract the platelet aggregation inhibitory effects.