Antiplatelet Agents in the Perioperative Period

O’Riordan, James M.; Margey, Ronan; Blake, Gavin J.; O’Connell, P. R.

doi:10.1001/archsurg.144.1.69

Cited by 81 publications

(35 citation statements)

References 106 publications

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“…[24][25][26] This may be due to the resultant rebound hypercoagulability characterised by increased thromboxane production and decreased fibrinolysis aggravating the pro-thrombotic state associated with surgery. 24 Conversely, continuing antiplatelet therapy throughout the perioperative period has implications on both surgical site bleeding and anaesthetic decision making, particularly with respect to the use of neuraxial techniques such as epidural or spinal anaesthesia.…”

Section: Perioperative Management Of Antiplatelet Agentsmentioning

confidence: 99%

Perioperative management of adult patients with a history of stroke or transient ischaemic attack undergoing elective non-cardiac surgery

et al. 2016

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It is increasingly common for physicians and anaesthetists to be asked for advice in the medical management of surgical patients who have an incidental history of stroke or transient ischaemic attack (TIA). Advising clinicians requires an understanding of the common predictors, outcomes and management of perioperative stroke. The most important predictor of perioperative stroke is a previous history of stroke, and outcomes associated with such an event are extremely poor. The perioperative management of this patient group needs careful consideration to minimise the thrombotic risk and a comprehensive, individualised approach is crucial. Although there is literature supporting the management of such patients undergoing cardiac surgery, evidence is lacking in the setting of noncardiac surgical intervention. This article reviews the current evidence and provides a pragmatic interpretation to inform the perioperative management of patients with a history of stroke and/or TIA presenting for elective non-cardiac surgery.

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Section: Perioperative Management Of Antiplatelet Agentsmentioning

confidence: 99%

Perioperative management of adult patients with a history of stroke or transient ischaemic attack undergoing elective non-cardiac surgery

et al. 2016

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“…Bu nedenle, antiplatelet ilaçlar aterosklerotik trombotik hastalıkların primer ve sekonder yönetiminin temel kısmını oluşturmaktadır ve yaygın olarak kullanılmaktadırlar [6,7]. Oral antiplatelet ajanların güncel kullanım endikasyonları Tablo 1'de özetlenmiştir [8].…”

Section: Antiplatelet Tedaviunclassified

“…Bu inhibisyon trombositlerde kalıcı iken endotel hücre-leri kısa sürede normale döner. Bu nedenle asetil salisilik asit bir antitrombotik ajandır [8]. Asetil salisilik asit çoğunlukla kardiyovasküler ve serebrovasküler olayların primer proflaksisinde kullanılmaktadır [13].…”

Section: Antiplatelet Tedaviunclassified

“…Tienopiridinler trombositlerdeki P2Y12 reseptörlerine bağlana-rak endojen ve ekzojen adenozin difosfat üzerinden trombosit yanıtını inhibe eder. Bu grupta klopidogrel daha hızlı etki etmesi, günlük tek doz kullanım avantajı ve daha az yan etkiye sahip olması nedeniyle tiklopidinin yerini almıştır [8,12,13]. Tipik olarak unstabil anjina pektoriste ve koroner stent yerleştirilmesini takiben asetil salisilik asitin yerine veya asetil salisilik asite ek olarak kullanılır [13].…”

Section: Antiplatelet Tedaviunclassified

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Extracorporeal Shock Wave Lithotripsy in Patients Taking Antiplatelet Agents

Özer¹,

Güvel²

2013

Ann Clin Anal Med

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ÖzetEkstrakorporeal şok dalgası ile litotripsi sırasında antiplatelet ilaçlara devam edilmesi işleme bağlı kanama riskinde artışa neden olabilir. Bununla birlikte, bu ilaçlara geçici olarak ara verilmesi trombotik olay riskini arttırır. Bu yazı-nın amacı antiplatelet ilaç kullanan hastalarda ekstrakorporeal şok dalgası ile litotripsi yönetimini gözden geçirmektir. Anahtar Kelimeler ESWL; Antiplatelet İlaç; Kanama AbstractContinuation of antiplatelet agents during extracorporeal shock wave lithotripsy may lead to increased risk of procedure-related bleeding. However, temporary interruption of these agents increases the risk of thrombotic event. The aim of this article was to review the management of extracorporeal shock wave lithotripsy in patients taking antiplatelet agents.

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“…Recent data on the risk of discontinuing anti-platelet therapy in patients with coronary stents has focused on the continuation of aspirin in the perioperative period 87,89 . As a result of these studies, the routine withdrawal of acetylsalicylic acid 7-10 days prior to surgery has been questioned and review articles published recently recommend that acetylsalicylic acid treatment should not be stopped routinely in the perioperative perio 79,[103][104][105] . However, these recommendations are not based on evidence from controlled trials elucidating the risk/benefit of acetylsalicylic acid in a non-cardiovascular surgical setting.…”

Section: The Impact Of Myocardial Damage On Outcome Imentioning

confidence: 99%

Perioperative myocardial damage and cardiac outcome in patients‐at‐risk undergoing non‐cardiac surgery

Tibblin¹

2010

Acta Anaesthesiol Scand

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Despite increasingly sophisticated perioperative management, cardiovascular complications continue to be major challenges for the clinician. As a growing number of elderly patients with known coronary artery disease (CAD) or with risk factors for CAD are undergoing noncardiac surgery, cardiovascular complications will remain a significant clinical problem in the future. The overall objective of this thesis was to study the incidence of myocardial damage and perioperative adverse cardiac events, to determine predictors of poor outcome and to assess the effect of a medical intervention in patients at risk undergoing non-cardiac surgery. The studies in this thesis were conducted on a total of 952 patients undergoing non-cardiac surgery. Studies I and IV were multicenter studies; whereas the patients included in studies II and III underwent non-cardiac surgery at Linkoping University Hospital, Sweden. The correlation between postoperative myocardial damage and short-and long-term outcome were studied in 546 patients, aged 70 years or older undergoing non-cardiac surgery of at least 30 minutes duration. This study showed a close correlation between postoperative myocardial damage and poor short-as well as long-term outcome. Elevated Troponin T was a strong independent predictor of mortality within one year of surgery. In 186 patients with ASA physical status classification III or IV undergoing non-elective surgery, the incidence of myocardial damage was 33%. In this study preoperative myocardial damage was an independent predictor of major adverse cardiac events in the postoperative period. In 69 patients with ASA physical status classification III & IV undergoing acute hip surgery, we found a close correlation between elevated NT-proBNP value prior to surgery and cardiac complications in the postoperative period. To study the effect of acetylsalicylic acid on postoperative myocardial damage and cardiovascular events, 220 patients at risk were randomized to receive 75 mg of acetylsalicylic acid or placebo 7 days prior to surgery until the third postoperative day. This study showed that treatment with acetylsalicylic acid resulted in an 8% (95% CI 1-15%) absolute risk reduction of having a postoperative major adverse cardiac event. No statistically significant differences of bleeding complications were seen between the groups. In conclusion, this thesis contributes to the understanding of the clinical relevance of elevated cardiac markers (with or without clinical or ECG signs of myocardial damage) in patients undergoing elective or emergency surgery. Moreover, we have identified predictors of poor outcome in the perioperative period that could be used as tools for identifying patients at risk. Finally, we have shown that continuing acetylsalicylic acid in the perioperative period reduced the risk of major adverse cardiac events within 30 days of surgery.

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Antiplatelet Agents in the Perioperative Period

Cited by 81 publications

References 106 publications

Perioperative management of adult patients with a history of stroke or transient ischaemic attack undergoing elective non-cardiac surgery

Perioperative management of adult patients with a history of stroke or transient ischaemic attack undergoing elective non-cardiac surgery

Extracorporeal Shock Wave Lithotripsy in Patients Taking Antiplatelet Agents

Perioperative myocardial damage and cardiac outcome in patients‐at‐risk undergoing non‐cardiac surgery

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