Aspirin, clopidogrel, and the surgeon

Area of Science:

• Cardiology
• Pharmacology

Background:

• Antiplatelet therapy is increasingly used for cardiovascular and cerebrovascular event prevention.
• Perioperative management of antiplatelet therapy presents a clinical dilemma due to competing risks.

Purpose of the Study:

• To discuss the challenges and considerations for continuing antiplatelet therapy in the perioperative period.
• To provide guidance on balancing thrombotic and bleeding risks.

Main Methods:

• Review of current literature and guidelines on perioperative antiplatelet management.
• Analysis of the risks and benefits of continuing aspirin and thienopyridines.

Main Results:

• Aspirin continuation is favored due to its proven benefits in preventing thrombotic events.
• Thienopyridines (e.g., clopidogrel) should be maintained for recommended durations, especially post-stent placement.
• Maintaining antiplatelet therapy increases bleeding risk, necessitating careful individual patient assessment.

Conclusions:

• Perioperative guidelines offer limited clear solutions for managing antiplatelet therapy.
• Individualized patient management is crucial, weighing bleeding risk against thrombotic risk.
• Collaboration among healthcare providers is essential for optimal patient care.