Anti-platelet Aggregation in Non-Cardiac Surgery
Keywords:
Blood platelets, platelet aggregation inhibitors, therapeutics, perioperative care
Abstract
Objective. To review the indications and perioperative management considerations for anti-platelet aggregation (APT) therapy.
Methodology. Using “non-cardiac surgery”, “APT” and “apirine-clopidogrel” as key words, a non-systematic search was conducted in the PubMed/Medline and SciELO databases.
Results. APT is used frequently for the management of cardiovascular and non-cardiovascular medical entities. It is important to adopt a clear stance regarding the continuation, change or withdrawal of this therapy in the perioperative context. That decision must be based on a judicious assessment of the risk of bleeding and the risk of perioperative complications secondary to the withdrawal of the antiplatelet agent that has offered the patient adequate management before surgery.
Conclusion. In most cases of non-cardiac surgery, withdrawal of aspirin in patients with coronary heart disease, cerebral or peripheral vascular disease must be avoided if the risk of bleeding is considered low or moderate.
References
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4. Yusuf S, Zhao F, Mehta SR, et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001;345:494-502.
5. Park SJ, Park DW, Kim YH, et al. Duration of dual antiplatelet therapy after implantation of drug-eluting stents. N Engl J Med. 2010;362:1374-82.
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8. Albaladejo P, Samama CM. Patients under anti-platelet therapy. Best Pract Res Clin Anaesthesiol. 2010;24:41-50.
9. Leon MB, Baim DS, Popma JJ, et al. A clinical trial comparing three antithrombotic-drug regimens after coronary-artery stenting. Stent Anticoagulation Restenosis Study Investigators. N Engl J Med. 1998;339:1665-71.
10. Grines CL, Bonow RO, Casey DE, et al. Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents. Circulation. 2007;115:813-8.
11. Spertus JA, Kettelkamp R, Vance C, et al. Prevalence, predictors, and outcomes of premature discontinuation of thienopyridine therapy after drug eluting stent placement: results from the PREMIER registry. Circulation. 2006;113:2803-9.
12. Iakovou I, Schmidt T, Bonizzoni E, et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA. 2005;293:2126-30.
13. Mixed thoughts on how generic clopidogrel might impact patients, providers. HeartWire internet. 2006 citado: 17 de junio del 2011. Disponible en: http://www.theheart.org/article/729929.do.
14. Bavry AA, Kumbhani DJ, Helton TJ, et al. Late thrombosis of drug-eluting stents: A meta-analysis of randomized clinical trials. Am J Med. 2006;119:1056-61.
15. Collet JP, Montalescot G, Blanchet B, et al. Impact of prior use or recent withdrawal of oral antiplatelet agents on acute coronary syndromes. Circulation. 2004;110:2361-7.
16. Park DW, Park SW, Park KH, et al. Frequency of and risk factors for stent thrombosis after drug-eluting stent implantation during long-term follow-up. Am J Cardiol. 2006;98:352-6.
17. Albadalejo P, Geeraerts T, Francis F, et al. Aspirin withdrawal and acute lower limb ischemia. Anesth Analg. 2004;99:440-3.
18. Nielsen VG, Asmis LM. Hypercoagulability in the perioperative period. Best Pract Res Clin Anaesthesiol. 2010:24;133-44.
19. Goldman S, Copeland J, Moritz T, et al. Improvement in early saphenous graft patency after coronary artery bypass surgery with antiplatelet therapy: Results of a veterans administration cooperative study. Circulation. 1988;77:1324-32.
20. Lindblad B, Persson NH, Takolander R, et al. Does low-dose acetylsalicylic acid prevent trial. Stroke. 1993;24:1125-8.
21. Torosian M, Michelson EL, Morganroth J, et al. Aspirin and Coumadin related bleeding after coronary artery bypass surgery. Ann Intern Med. 1978;89:325-8.
23. Enver MK, Hoh I, Chinegwundoh FI. The management of aspirin in transurethral prostatectomy: current practice in the UK. Ann R Coll Surg Engl. 2006;88:280-3.
24. Mitchell SM, Sethia KK. Hazards of aspirin withdrawal before transurethral prostatectomy. BJU Int. 1999;84:530.
25. Kargi E, Babuccu O, Hosnuter M, et al. Complications of minor cutaneous surgery in patients under anticoagulant treatment. Aesthetic Plast Surg. 2002;26:483-5.
26. Korinth MC, Gilsbach JM, Weinzierl MR. Low-dose aspirin before spinal surgery: results of a survey among neurosurgeons in Germany. Eur Spine J. 2007;16:365-72.
27. Whitson M, Dikman A, Von Althann C, et al. Is gastroduodenal biopsy safe in patients receiving aspirin and clopidogrel?: a prospective, randomized study involving 630 biopsies. J Clin Gastroenterol. 2011;45:228-33.
28. Sierra P, Gómez-Luque A, Castillo J, et al. Guía de práctica clínica sobre el manejo perioperatorio de antiagregantes plaquetarios en cirugía no cardiaca. Rev Esp Anestesiol Reanim. 2011;58(Supl 1):1-16.
29. Korte W, Cattaneo M, Chassot PG, et al. Peri-operative management of antiplatelet therapy in patients with coronary artery disease. Thromb Haemost. 2011;105:743-9.
30. Kaluza GL, Jospeh J, Lee JR, et al. Catastrophic outcomes of noncardiac surgery soon after coronary stenting. J Am Coll Cardiol. 2000;35:1288-94.
31. Ebrahimi R, Dyke C, Mehran R, et al. Outcomes following pre-operative clopidogrel administration in patients with acute coronary syndromes undergoing coronary artery bypass surgery. J Am Coll Cardiol. 2009;53:1965-72.
32. Samama CM, Bonnin P, Bonneau M et al. Comparative arterial antithrombotic activity of clopidogrel and acetyl salicylic acid in the pig. Thromb Haemost. 1992;68:500-5.
33. Oscarsson A, Gupta A, Fredrikson M, et al. To continue or discontinue aspirin in the perioperative period: a randomized, controlled clinical trial. Br J Anaesth. 2010;104:305-12.
34. Urmey WF, Rowlingson JC. Do antiplatelet agents contribute to the development of perioperative spinal hematoma? Reg Anesth Pain Med. 1998;23(6 Suppl 2):146-51.
35. Vandermeulen E. Regional anaesthesia and anticoagulation. Best Pract Res Clin Anaesthesiol. 2011;24:121-1.
36. Horlocker TT, Wedel DJ, Benzon H, et al. Regional anesthesia in the anticoagulated patient: defining the risks (the second ASRA Consensus Conference on Neuraxial Anesthesia and Anticoagulation) Reg Anesth Pain Med. 2003;28:172-97.
37. Steve C, Rosenfeld PJ, Gayer S. Medical consequences of stopping anticoagulant therapy before intraocular surgery or intravitreal injections. Retina. 2007;27:813-5.
38. Narendran N, Williamson TH. The effects of aspirin and warfarin on haemorrhage in vitreoretinal surgery. Acta Opthalmol Scand. 2003;81:38-40.
39. Morice MC, Serruys PW, Sousa JE, et al. A randomized comparison of a sirolimuseluting stent with a standard stent for coronary revascularization. N Engl J Med. 2002;346:1773-80.
40. Moses JW, Leon MB, Popma JJ, et al. Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med. 2003:49:1315-23.
41. Stone GW, Ellis SG, Cox DA, et al. A polymer-based paclitaxel-eluting stent in patients with coronary artery disease. N Engl J Med. 2004;350:221-31.
42. McFadden EP, Stabile E, Regar E, et al. Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy. Lancet. 2004;364:1519-21.
43. Ong ATL, McFadden EP, Regar E, et al. Late angiographic stent thrombosis (LAST) events with drug-eluting stents. J Am Coll Cardiol. 2005;45:2088-92.
44. Daemen J, Wenaweser P, Tsuchida K, et al. Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a larger two-institutional cohort study. Lancet. 2007;369:667-78.
45. Kotani J, Awata M, Nanto S, et al. Incomplete neointimal coverage of sirolimuseluting stents: angioscopic findings. J Am Coll Cardiol. 2006;47:2108-11.
46. Albadalejo P, Marret E, Piriou V, et al. Perioperative management of antiplatelet agents in patients with coronary stents: recommendations of a French Task Force. Br J Anaesth. 2006;97:580-2.
47. Fleisher LA, Beckman JA, Brown KA, et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery. Circulation. 2007;116:e418-99.
48. Hall R, Mazer CD. Antiplatelet drugs: a review of their pharmacology and management in the perioperative period. Anesth Analg. 2011;112:292-318.
49. Lugo JJ, Hurtado EF, Calderón LI, et al. Resistencia al ácido acetil salicílico y al clopidogrel: una entidad clínica emergente. Revista Colombiana de Cardiología. 2008;15:172-83.
50. STRATAGEM: Strategy for Managing Antiplatelet Therapy in the Perioperative Period of Non Coronary Surgery internet. 2011 citado: 17 de junio del 2011. Disponible en: http://clinicaltrials.gov/ct2/show/NCT00190307.
2. Bhatt DL, Fox KA, Hacke W, et al. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med. 2006;354:1706-17.
3. Sabatine MS, Cannon CP, Gibson CM, et al. Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation. N Engl J Med. 2005;352:1179-89.
4. Yusuf S, Zhao F, Mehta SR, et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001;345:494-502.
5. Park SJ, Park DW, Kim YH, et al. Duration of dual antiplatelet therapy after implantation of drug-eluting stents. N Engl J Med. 2010;362:1374-82.
6. Ferrari E, Benhamou M, Cerboni P, et al. Coronary syndromes following aspirin withdrawal. J Am Coll Cardiol. 2005;45:456-9.
7. Biondi-Zoccai GGL, Lotrionte M, Agostoni P, et al. A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50 279 patients at risk for coronary artery disease. Eur Heart J. 2006;27:2667-74.
8. Albaladejo P, Samama CM. Patients under anti-platelet therapy. Best Pract Res Clin Anaesthesiol. 2010;24:41-50.
9. Leon MB, Baim DS, Popma JJ, et al. A clinical trial comparing three antithrombotic-drug regimens after coronary-artery stenting. Stent Anticoagulation Restenosis Study Investigators. N Engl J Med. 1998;339:1665-71.
10. Grines CL, Bonow RO, Casey DE, et al. Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents. Circulation. 2007;115:813-8.
11. Spertus JA, Kettelkamp R, Vance C, et al. Prevalence, predictors, and outcomes of premature discontinuation of thienopyridine therapy after drug eluting stent placement: results from the PREMIER registry. Circulation. 2006;113:2803-9.
12. Iakovou I, Schmidt T, Bonizzoni E, et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA. 2005;293:2126-30.
13. Mixed thoughts on how generic clopidogrel might impact patients, providers. HeartWire internet. 2006 citado: 17 de junio del 2011. Disponible en: http://www.theheart.org/article/729929.do.
14. Bavry AA, Kumbhani DJ, Helton TJ, et al. Late thrombosis of drug-eluting stents: A meta-analysis of randomized clinical trials. Am J Med. 2006;119:1056-61.
15. Collet JP, Montalescot G, Blanchet B, et al. Impact of prior use or recent withdrawal of oral antiplatelet agents on acute coronary syndromes. Circulation. 2004;110:2361-7.
16. Park DW, Park SW, Park KH, et al. Frequency of and risk factors for stent thrombosis after drug-eluting stent implantation during long-term follow-up. Am J Cardiol. 2006;98:352-6.
17. Albadalejo P, Geeraerts T, Francis F, et al. Aspirin withdrawal and acute lower limb ischemia. Anesth Analg. 2004;99:440-3.
18. Nielsen VG, Asmis LM. Hypercoagulability in the perioperative period. Best Pract Res Clin Anaesthesiol. 2010:24;133-44.
19. Goldman S, Copeland J, Moritz T, et al. Improvement in early saphenous graft patency after coronary artery bypass surgery with antiplatelet therapy: Results of a veterans administration cooperative study. Circulation. 1988;77:1324-32.
20. Lindblad B, Persson NH, Takolander R, et al. Does low-dose acetylsalicylic acid prevent trial. Stroke. 1993;24:1125-8.
21. Torosian M, Michelson EL, Morganroth J, et al. Aspirin and Coumadin related bleeding after coronary artery bypass surgery. Ann Intern Med. 1978;89:325-8.
23. Enver MK, Hoh I, Chinegwundoh FI. The management of aspirin in transurethral prostatectomy: current practice in the UK. Ann R Coll Surg Engl. 2006;88:280-3.
24. Mitchell SM, Sethia KK. Hazards of aspirin withdrawal before transurethral prostatectomy. BJU Int. 1999;84:530.
25. Kargi E, Babuccu O, Hosnuter M, et al. Complications of minor cutaneous surgery in patients under anticoagulant treatment. Aesthetic Plast Surg. 2002;26:483-5.
26. Korinth MC, Gilsbach JM, Weinzierl MR. Low-dose aspirin before spinal surgery: results of a survey among neurosurgeons in Germany. Eur Spine J. 2007;16:365-72.
27. Whitson M, Dikman A, Von Althann C, et al. Is gastroduodenal biopsy safe in patients receiving aspirin and clopidogrel?: a prospective, randomized study involving 630 biopsies. J Clin Gastroenterol. 2011;45:228-33.
28. Sierra P, Gómez-Luque A, Castillo J, et al. Guía de práctica clínica sobre el manejo perioperatorio de antiagregantes plaquetarios en cirugía no cardiaca. Rev Esp Anestesiol Reanim. 2011;58(Supl 1):1-16.
29. Korte W, Cattaneo M, Chassot PG, et al. Peri-operative management of antiplatelet therapy in patients with coronary artery disease. Thromb Haemost. 2011;105:743-9.
30. Kaluza GL, Jospeh J, Lee JR, et al. Catastrophic outcomes of noncardiac surgery soon after coronary stenting. J Am Coll Cardiol. 2000;35:1288-94.
31. Ebrahimi R, Dyke C, Mehran R, et al. Outcomes following pre-operative clopidogrel administration in patients with acute coronary syndromes undergoing coronary artery bypass surgery. J Am Coll Cardiol. 2009;53:1965-72.
32. Samama CM, Bonnin P, Bonneau M et al. Comparative arterial antithrombotic activity of clopidogrel and acetyl salicylic acid in the pig. Thromb Haemost. 1992;68:500-5.
33. Oscarsson A, Gupta A, Fredrikson M, et al. To continue or discontinue aspirin in the perioperative period: a randomized, controlled clinical trial. Br J Anaesth. 2010;104:305-12.
34. Urmey WF, Rowlingson JC. Do antiplatelet agents contribute to the development of perioperative spinal hematoma? Reg Anesth Pain Med. 1998;23(6 Suppl 2):146-51.
35. Vandermeulen E. Regional anaesthesia and anticoagulation. Best Pract Res Clin Anaesthesiol. 2011;24:121-1.
36. Horlocker TT, Wedel DJ, Benzon H, et al. Regional anesthesia in the anticoagulated patient: defining the risks (the second ASRA Consensus Conference on Neuraxial Anesthesia and Anticoagulation) Reg Anesth Pain Med. 2003;28:172-97.
37. Steve C, Rosenfeld PJ, Gayer S. Medical consequences of stopping anticoagulant therapy before intraocular surgery or intravitreal injections. Retina. 2007;27:813-5.
38. Narendran N, Williamson TH. The effects of aspirin and warfarin on haemorrhage in vitreoretinal surgery. Acta Opthalmol Scand. 2003;81:38-40.
39. Morice MC, Serruys PW, Sousa JE, et al. A randomized comparison of a sirolimuseluting stent with a standard stent for coronary revascularization. N Engl J Med. 2002;346:1773-80.
40. Moses JW, Leon MB, Popma JJ, et al. Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med. 2003:49:1315-23.
41. Stone GW, Ellis SG, Cox DA, et al. A polymer-based paclitaxel-eluting stent in patients with coronary artery disease. N Engl J Med. 2004;350:221-31.
42. McFadden EP, Stabile E, Regar E, et al. Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy. Lancet. 2004;364:1519-21.
43. Ong ATL, McFadden EP, Regar E, et al. Late angiographic stent thrombosis (LAST) events with drug-eluting stents. J Am Coll Cardiol. 2005;45:2088-92.
44. Daemen J, Wenaweser P, Tsuchida K, et al. Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a larger two-institutional cohort study. Lancet. 2007;369:667-78.
45. Kotani J, Awata M, Nanto S, et al. Incomplete neointimal coverage of sirolimuseluting stents: angioscopic findings. J Am Coll Cardiol. 2006;47:2108-11.
46. Albadalejo P, Marret E, Piriou V, et al. Perioperative management of antiplatelet agents in patients with coronary stents: recommendations of a French Task Force. Br J Anaesth. 2006;97:580-2.
47. Fleisher LA, Beckman JA, Brown KA, et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery. Circulation. 2007;116:e418-99.
48. Hall R, Mazer CD. Antiplatelet drugs: a review of their pharmacology and management in the perioperative period. Anesth Analg. 2011;112:292-318.
49. Lugo JJ, Hurtado EF, Calderón LI, et al. Resistencia al ácido acetil salicílico y al clopidogrel: una entidad clínica emergente. Revista Colombiana de Cardiología. 2008;15:172-83.
50. STRATAGEM: Strategy for Managing Antiplatelet Therapy in the Perioperative Period of Non Coronary Surgery internet. 2011 citado: 17 de junio del 2011. Disponible en: http://clinicaltrials.gov/ct2/show/NCT00190307.
How to Cite
1.
Garcia Araque HF, Oliveros Acosta D. Anti-platelet Aggregation in Non-Cardiac Surgery. Colomb. J. Anesthesiol. [Internet]. 2011 Oct. 1 [cited 2024 Apr. 19];39(4):561-7. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/641
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2011-10-01
How to Cite
1.
Garcia Araque HF, Oliveros Acosta D. Anti-platelet Aggregation in Non-Cardiac Surgery. Colomb. J. Anesthesiol. [Internet]. 2011 Oct. 1 [cited 2024 Apr. 19];39(4):561-7. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/641
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