Antiplatelet agents in perioperative noncardiac surgeries: to maintain or to suspend?

Borges, Juliana Maria Dantas Mendonça; Carvalho, Fernanda Oliveira de; Gomes, Isla Alcântara; Rosa, Mário Borges; Sousa, Antônio Carlos Sobral

doi:10.2147/tcrm.s172591

Cited by 8 publications

(5 citation statements)

References 44 publications

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“…This outcome is associated with the fact that adequate local treatment was applied. Similar conclusions were reported by authors of experimental control studies [30,31].…”

Section: Discussionsupporting

confidence: 92%

Analysing the effectiveness of topical bleeding care following tooth extraction in patients receiving dual antiplatelet therapy-retrospective observational study

et al. 2021

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Background Patients using antiplatelet drugs following infarctions, acute coronary syndrome or stroke pose a significant clinical problem if it is necessary to perform surgery, including dental surgery, since they are at risk of prolonged or secondary post-extraction bleeding. Discontinuation of this therapy is associated with a high risk of serious thromboembolic complications. The purpose of this study was to assess the effectiveness of TachoSil fibrin-collagen patches in stopping and preventing of secondary post-extraction bleeding in patients undergoing chronic antiplatelet therapy. Methods The study was conducted through retrospective examination of the medical records of 153 patients using chronic antiplatelet therapy and those qualified for tooth extraction. The largest group comprised 74 patients using aspirin and clopidogrel as dual platelet antiaggregation therapy; in this group 75 tooth extractions were carried out. In all of the patients TachoSil fibrin-collagen patches and stiches were applied to the wounds resulting from tooth removal. Results Following tooth extraction, primary bleeding was stopped in all the patients and their wounds closed via coagulation within 20–30 min. In eight cases, accounting for 4.9% of the patients, secondary bleeding occurred and was successfully stopped only by applying a pressure dressing soaked in tranexamic acid. Secondary bleeding occurred in three patients on the second day and in five patients on the third day following tooth removal. Conclusion Topical application of TachoSil patches following tooth removal in patients using single or dual antiplatelet therapy effectively stopped bleeding and prevented secondary bleeding after tooth extraction.

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“…This outcome is associated with the fact that adequate local treatment was applied. Similar conclusions were reported by authors of experimental control studies [30,31].…”

Section: Discussionsupporting

confidence: 92%

Analysing the effectiveness of topical bleeding care following tooth extraction in patients receiving dual antiplatelet therapy-retrospective observational study

et al. 2021

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“…Most neurosurgical procedures are of the moderate or high-risk category. Unlike in other types of surgeries, antiplatelet drugs (even low-dose acetylsalicylic acid) are usually discontinued before the operation [2,9,15]. In addition, the restart time of antiplatelet therapy is usually delayed as compared with that in other surgeries.…”

Section: Introductionmentioning

confidence: 99%

Perioperative myocardial injury after elective neurosurgery: incidence, risk factors, and effects on mortality

et al. 2022

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BackgroundPerioperative myocardial injury is an important reason of mortality and morbidity after neurosurgery. It usually is missed due to asymptomatic character. In the present study, we investigated myocardial injury after noncardiac surgery (MINS) incidence, the risk factor for MINS and association of MINS with 30-day mortality in neurosurgery patients. MethodsPatients with cardiac risk who underwent elective neurosurgery were enrolled to the study. The patients' demographics, comorbidities, medications used, medical history, and type of operation were recorded.The high-sensitivity cardiac troponin (hs-cTn) levels of the patients were measured 12, 24, and 48 hours after surgery. The patients were considered as MINS-positive if at least one of their postoperative hs-cTn measurement values was ≥14 ng/l. All the patients were followed up for 30 days after surgery for evaluation of their outcomes, including total mortality, mortality due to cardiovascular cause, and major cardiac events. ResultsTotal 312 patients completed the study and 64 (20.5%) of them was MINS positive. Long antiplatelet or anticoagulant drug cessation time (OR: 4.9, 95%CI: 2.1-9.4) was found the most prominent risk factor for MINS occurrence. Total mortality rate was 2.4% and 6.2% in patients MINS negative and positive respectively (p = 0.112). The mortality rate due to cardiovascular reasons (0.8% for without MINS, 4.7for with MINS, and p=0.026) and incidence of the major cardiac event (4% for without MINS, 10.9 for with MINS, and p=0.026) were signi cantly higher in patients with MINS. ConclusionsMINS is a common problem after neurosurgery and, high postoperative hs-cTn level is associated with mortality and morbidity.

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Section: Introductionmentioning

confidence: 99%

Perioperative Myocardial Injury After Elective Neurosurgery: Incidence, Risk Factors and Effects on Mortality.

Saka

Abdullah

Canbaz

et al. 2021

Preprint

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BackgroundPerioperative myocardial injury is an important reason of mortality and morbidity after neurosurgery. It usually is missed due to asymptomatic character. In the present study, we investigated myocardial injury after noncardiac surgery (MINS) incidence, the risk factor for MINS and association of MINS with 30-day mortality in neurosurgery patients.MethodsPatients with cardiac risk who underwent elective neurosurgery were enrolled to the study. The patients’ demographics, comorbidities, medications used, medical history, and type of operation were recorded. The high-sensitivity cardiac troponin (hs-cTn) levels of the patients were measured 12, 24, and 48 hours after surgery. The patients were considered as MINS-positive if at least one of their postoperative hs-cTn measurement values was ≥14 ng/l. All the patients were followed up for 30 days after surgery for evaluation of their outcomes, including total mortality, mortality due to cardiovascular cause, and major cardiac events.ResultsTotal 312 patients completed the study and 64 (20.5%) of them was MINS positive. Long antiplatelet or anticoagulant drug cessation time (OR: 4.9, 95%CI: 2.1-9.4) was found the most prominent risk factor for MINS occurrence. Total mortality rate was 2.4% and 6.2% in patients MINS negative and positive respectively (p = 0.112). The mortality rate due to cardiovascular reasons (0.8% for without MINS, 4.7for with MINS, and p=0.026) and incidence of the major cardiac event (4% for without MINS, 10.9 for with MINS, and p=0.026) were significantly higher in patients with MINS.ConclusionsMINS is a common problem after neurosurgery and, high postoperative hs-cTn level is associated with mortality and morbidity.

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Antiplatelet agents in perioperative noncardiac surgeries: to maintain or to suspend?

Cited by 8 publications

References 44 publications

Analysing the effectiveness of topical bleeding care following tooth extraction in patients receiving dual antiplatelet therapy-retrospective observational study

Analysing the effectiveness of topical bleeding care following tooth extraction in patients receiving dual antiplatelet therapy-retrospective observational study

Perioperative myocardial injury after elective neurosurgery: incidence, risk factors, and effects on mortality

Perioperative Myocardial Injury After Elective Neurosurgery: Incidence, Risk Factors and Effects on Mortality.

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