Anesthetic implications of the new anticoagulant and antiplatelet drugs

Vitin, Alexander A.; Dembo, Gregory; Vater, Youri; Martay, Kenneth; Azamfirei, Leonard; Ezri, Tiberiu

doi:10.1016/j.jclinane.2007.10.013

Cited by 5 publications

(1 citation statement)

References 143 publications

(153 reference statements)

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“…Apart from increased perioperative blood loss, one must be wary of increased bleeding caused by many of our anesthetic procedures, including the possibility of epidural hematoma with neuraxial techniques and nasal bleeding after nasotracheal intubation and nasogastric tube placement. 52 ASA mildly increases blood loss following cardiac surgery, though the data on whether it increases transfusion requirements are inconsistent. 53 In patients undergoing noncardiac surgery, ASA has been shown to increase the frequency of bleeding by approximately 50% but does not increase the risk of bleeding complications or mortality with the possible exceptions of intracranial neurosurgery 54 and prostatectomy.…”

Section: Continuing Antiplatelet Therapy and The Risk Of Bleedingmentioning

confidence: 99%

The Management of Antiplatelet Therapy in Patients With Coronary Stents Undergoing Noncardiac Surgery

Chen

Matyal

2010

Semin Cardiothorac Vasc Anesth

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Whereas the development of coronary stents has been a major breakthrough in the treatment of coronary artery disease, stent thrombosis, associated with myocardial infarction and death, has introduced a new challenge in the care of patients with coronary stents undergoing noncardiac surgery. This review presents the authors' recommendations regarding the optimal management of such patients. Elective surgery should be postponed for at least 6 weeks and optimally 3 months for a bare-metal stent and at least 1 year for a drug-eluting stent. On the other hand, managing a patient undergoing non-elective surgery is more difficult and necessitates a case-by-case assessment of bleeding risk versus thrombotic risk based on patient comorbidities, type of stents present, details of the coronary intervention, and type of surgical procedure. Patients with a risk of bleeding that outweighs the risk of stent thrombosis should discontinue at least clopidogrel, whereas all other patients should continue dual antiplatelet therapy throughout the perioperative period.

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Section: Continuing Antiplatelet Therapy and The Risk Of Bleedingmentioning

confidence: 99%