How to undertake procedures while on antiplatelet agents: a hematologist's view

Area of Science:

• Cardiology
• Pharmacology
• Surgical Management

Background:

• Cardiovascular diseases (CVDs) are a leading global cause of mortality and healthcare expenditure.
• Antiplatelet medications are crucial for secondary CVD prevention, especially with increased use of vascular devices.
• A significant complication of antiplatelet therapy is an increased risk of bleeding, posing challenges for patients requiring surgery.

Purpose of the Study:

• To provide a clinical approach for managing patients on antiplatelet drugs who require urgent surgical interventions.
• To address the lack of robust guidelines for managing antiplatelet therapy in surgical patients.
• To balance the risks of bleeding and thrombotic events in this patient population.

Main Methods:

• This is a review article, synthesizing current evidence and expert opinion.
• The approach focuses on risk assessment for both bleeding and thrombosis.
• Consideration of drug properties, surgical urgency, and patient-specific factors.

Main Results:

• No specific results from a study, but outlines a structured approach to decision-making.
• Highlights the dilemma between withholding antiplatelet agents (risk of thrombosis) and continuing them (risk of bleeding).
• Emphasizes individualized patient management based on risk stratification.

Conclusions:

• Effective management requires careful consideration of individual patient risks and surgical context.
• The review aims to guide clinicians in making informed decisions regarding antiplatelet therapy cessation or continuation around surgery.
• Further research is needed to establish definitive guidelines for managing antiplatelet therapy in patients undergoing surgery.