Perioperative antiplatelet therapy: the case for continuing therapy in patients at risk of myocardial infarction

被引:198
作者
Chassot, P.-G. [1 ]
Delabays, A.
Spahn, D. R.
机构
[1] CHU Vaudois, Univ Lausanne Hosp, Dept Anaesthesiol, CH-1011 Lausanne, Switzerland
[2] CHU Vaudois, Univ Lausanne Hosp, Dept Cardiol, CH-1011 Lausanne, Switzerland
[3] Univ Zurich Hosp, Inst Anaesthesiol, CH-8091 Zurich, Switzerland
关键词
complications; haemorrhage; myocardial infarction; coronary stenosis; drug therapy; platelet aggregation inhibitors; therapeutic use; surgery; non-cardiac;
D O I
10.1093/bja/aem209
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Recent clinical data show that the risk of coronary thrombosis after antiplatelet drugs withdrawal is much higher than that of surgical bleeding if they are continued. In secondary prevention, aspirin is a lifelong therapy and should never be stopped. Clopidogrel is regarded as mandatory until the coronary stents are fully endothelialized, which takes 3 months for bare metal stents, but up to 1 yr for drug-eluting stents. Therefore, interruption of antiplatelet therapy 10 days before surgery should be revised. After reviewing the data on the use of antiplatelet drugs in cardiology and in surgery, we propose an algorithm for the management of patients, based on the risk of myocardial ischaemia. and death compared with that of bleeding, for different types of surgery. Even if large prospective studies with a high degree of evidence are still lacking on different antiplatelet regimens during non-cardiac surgery, we propose that, apart from low coronary risk situations, patients on antiplatelet drugs should continue their treatment throughout surgery, except when bleeding might occur in a closed space. A therapeutic bridge with shorter-acting antiplatelet drugs may be considered.
引用
收藏
页码:316 / 328
页数:13
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