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Peri-operative management of antiplatelet therapy in patients with coronary artery disease

Journal: Thrombosis and Haemostasis
ISSN: 0340-6245
Topic:

Theme Issue
Intravital imaging of inflammation

DOI: http://dx.doi.org/10.1160/TH10-04-0217
Issue: 2011: 105/5(May) pp. 743-932
Pages: 743-749
Ahead of Print: ###MANUSCRIPT_aheadofprint###

Peri-operative management of antiplatelet therapy in patients with coronary artery disease

Joint position paper by members of the working group on Perioperative Haemostasis of the Society on Thrombosis and Haemostasis Research (GTH), the working group on Perioperative Coagulation of the Austrian Society for Anesthesiology, Resuscitation and Intensive Care (ÖGARI) and the Working Group Thrombosis of the European Society for Cardiology (ESC)

See also Editorial by Peter, Myles

W. Korte (1), M. Cattaneo (2), P.-G. Chassot (3), S. Eichinger (4), C. von Heymann (5), N. Hofmann (6), H. Rickli (7), M. Spannagl (8), B. Ziegler (9), F. Verheugt (10), K. Huber (11)

(1) Center for Laboratory Medicine, Kantonsspital St. Gallen, Switzerland; (2) Medicina 3, Ospedale San Paolo, Department of Medicine, Surgery and Dentistry, Università degli Studi di Milano, Milan, Italy; (3) Departement of Anesthesiology, University Hospital Lausanne, Switzerland; (4) Department of Medicine I, Division of Hematology, Medical University of Vienna, Austria; (5) Department of Anesthesiology and Intensive Care, Charité-Universitätsmedizin Berlin, Germany; (6) Department of Anesthesiology, Diakonissen-Krankenhaus Salzburg, Austria; (7) Division of Cardiology, Kantonsspital St. Gallen, Switzerland; (8) Division of Haemostaseology, University of Munich, Germany; (9) Department of Anesthesiology, Landeskliniken Salzburg, Austria; (10) Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands; (11) 3rd Department of Medicine, Wilhelminenhospital, Vienna, Austria

Keywords

Atherosclerosis, surgery, atherothrombosis, coronary syndrome, Antiplatelet agents

Summary

An increasing number of patients suffering from cardiovascular disease, especially coronary artery disease (CAD), are treated with aspirin and/or clopidogrel for the prevention of major adverse events. Unfortunately, there are no specific, widely accepted recommendations for the perioperative management of patients receiving antiplatelet therapy. Therefore, members of the Perioperative Haemostasis Group of the Society on Thrombosis and Haemostasis Research (GTH), the Perioperative Coagulation Group of the Austrian Society for Anesthesiology, Reanimation and Intensive Care (ÖGARI) and the Working Group Thrombosis of the European Society of Cardiology (ESC) have created this consensus position paper to provide clear recommendations on the perioperative use of anti-platelet agents (specifically with semi-urgent and urgent surgery), strongly supporting a multidisciplinary approach to optimize the treatment of individual patients with coronary artery disease who need major cardiac and non-cardiac surgery. With planned surgery, drug eluting stents (DES) should not be used unless surgery can be delayed for ≥12 months after DES implantation. If surgery cannot be delayed, surgical revascularisation, bare-metal stents or pure balloon angioplasty should be considered. During ongoing antiplatelet therapy, elective surgery should be delayed for the recommended duration of treatment. In patients with semi-urgent surgery, the decision to prematurely stop one or both antiplatelet agents (at least 5 days pre-operatively) has to be taken after multidisciplinary consultation, evaluating the individual thrombotic and bleeding risk. Urgently needed surgery has to take place under full antiplatelet therapy despite the increased bleeding risk. A multidisciplinary approach for optimal antithrombotic and haemostatic patient management is thus mandatory.

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