2012 Update to The Society of Thoracic Surgeons Guideline on Use of Antiplatelet Drugs in Patients Having Cardiac and Noncardiac Operations

Ferraris, Victor A.; Saha, Sibu P.; Oestreich, Julie H.; Song, Howard K.; Rosengart, Todd K.; Reece, T. Brett; Mazer, C. David; Bridges, Charles R.; Despotis, George J.; Jointer, Kanae; Clough, Ellen R.

doi:10.1016/j.athoracsur.2012.07.086

Cited by 262 publications

(232 citation statements)

References 213 publications

Supporting

Mentioning

212

Contrasting

Unclassified

Order By: Relevance

“…10,11 In this context, surgeons are often faced with a potentially increased risk of bleeding associated with dual antiplatelet therapy, which is frequently exacerbated by the deleterious effect of cardiopulmonary bypass. Because of a lack of evidence, it is recommended that the heart team should estimate the individual risk of bleeding and cardiovascular events to guide the optimal antithrombotic management of patients receiving dual antiplatelet therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Because of a lack of evidence, it is recommended that the heart team should estimate the individual risk of bleeding and cardiovascular events to guide the optimal antithrombotic management of patients receiving dual antiplatelet therapy. [5][6][7]11 Although current guidelines recommend that administration of ticagrelor should be withheld for at least 5 days before CABG, unstable conditions do not allow waiting for washout of this potent antiplatelet agent. 8,9,11 One of the most clinically important observations in this study was that discontinuation of ticagrelor therapy more than 24 hours before surgery in the group receiving ticagrelor with or without aspirin was not associated with an increased risk of major bleeding complications compared with patients receiving aspirin alone.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 Indeed, in the Platelet Inhibition and Patient Outcomes (PLATO) trial, 3 it was recommended that, in patients undergoing CABG, administration of ticagrelor should be withheld for 24 to 72 hours, and prior guidelines suggested a shorter discontinuation of treatment in patients requiring urgent CABG. 10,11 The absence of randomized studies makes it difficult to establish the exact risk of bleeding complications after perioperative ticagrelor administration and its optimal timing of discontinuation before surgery. [12][13][14][15] To our knowledge, no data exist on any possible increased risk of bleeding associated with exposure to ticagrelor with or without aspirin compared with aspirin alone among patients with ACS undergoing CABG.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Safety of Preoperative Use of Ticagrelor With or Without Aspirin Compared With Aspirin Alone in Patients With Acute Coronary Syndromes Undergoing Coronary Artery Bypass Grafting

et al. 2016

View full text Add to dashboard Cite

IMPORTANCEThe optimal timing of discontinuation of ticagrelor before cardiac surgery is controversial.OBJECTIVE To evaluate the safety of preoperative use of ticagrelor with or without aspirin in patients with acute coronary syndromes (ACS) undergoing isolated coronary artery bypass grafting (CABG) compared with aspirin alone. DESIGN, SETTING, AND PARTICIPANTSThis prospective, multicenter clinical trial was performed at 15 European centers of cardiac surgery. Participants were patients with ACS undergoing isolated CABG from the European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) registry between January and September 2015.EXPOSURES Before surgery, patients received ticagrelor with or without aspirin or aspirin alone. MAIN OUTCOMES AND MEASURESSevere bleeding as defined by the Universal Definition of Perioperative Bleeding (UDPB) and E-CABG bleeding classification criteria. A propensity score-matched analysis was performed to adjust for differences in baseline and operative covariates.RESULTS Of 2482 patients from the E-CABG registry, the study cohort included 786 (31.7%) consecutive patients with ACS (mean [SD] age, 67.1 [9.3] years; range, 32-88 years), and 132 (16.8%) were female. One-to-one propensity score matching provided 215 pairs, whose baseline and operative covariates had a standardized difference of less than 10%. Preoperative use of ticagrelor was associated with a similar risk of bleeding according to the UDPB and E-CABG bleeding classifications, but the incidence of platelet transfusion was higher in the ticagrelor group (13.5% [29 of 215] vs 6.0% [13 of 215]. Compared with those receiving aspirin alone, continuing ticagrelor up to the time of surgery or discontinuing its use less than 2 days before surgery was associated with a higher risk of platelet transfusion . Among patients in whom antiplatelet drug use was discontinued at least 2 days before surgery, the incidence of platelet transfusion was 12. 4% (24 of 193) in the ticagrelor group and 3.6% (1 of 28) in the aspirin-alone group. CONCLUSIONS AND RELEVANCEIn propensity score-matched analyses among patients with ACS undergoing CABG, the use of preoperative ticagrelor with or without aspirin compared with aspirin alone was associated with more platelet transfusion but similar degree of bleeding; in patients receiving ticagrelor 1 day before or up until surgery, there was an increased rate of severe bleeding.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Safety of Preoperative Use of Ticagrelor With or Without Aspirin Compared With Aspirin Alone in Patients With Acute Coronary Syndromes Undergoing Coronary Artery Bypass Grafting

et al. 2016

View full text Add to dashboard Cite

show abstract

“…74 In contrast, other guidelines recommend using platelet function tests for optimal timing of surgery, as discussed in a recent publication. 134,135 However, the guidelines do not provide the 'ideal' platelet function assay or a 'bleeding cut-off', and more research in this area is needed.…”

Section: Dual Anti-platelet Therapymentioning

confidence: 99%

2014 ESC/ESA Guidelines on Non-cardiac Surgery: Cardiovascular Assessment and Management

Kristensen¹,

Knuuti²,

Saraste³

et al. 2014

Revista Española de Cardiología (English Edition)

View full text Add to dashboard Cite

“…Экспер-ты Американского общества торакальных хи-рургов (2012), а также Европейского общества кардиологов и Европейского общества анесте-зиологов (2014) считают обоснованным тес-тирование тромбоцитов больным, принимаю-щим ДАТ, которым необходимо оперативное (в том числе некардиальное) вмешательство [21,22].…”

unclassified

Individual Approach to Patients With Indication for Antiplatelet Therapy. What to Rely on in Choosing the Therapy?

Lomakin¹,

Сумароков²,

Доценко³

et al. 2017

Aterotromboz

View full text Add to dashboard Cite

Н акопленный опыт применения антиаг-регантной терапии у больных ИБС поз-волил сформулировать некоторые крае-угольные положения лечения препаратами дан-ного ряда. Во-первых, антиагреганты, безуслов-но, нужны и полезны при лечении ИБС.Прежде всего, это четко видно у больных ОКС и после имплантации коронарного стен-та, где их широкое внедрение позволило зна-чительно улучшить исходы болезни. Во-вто-рых, назначая антиагрегант или комбинацию препаратов этого класса, врач должен предви-деть возможности как чрезмерной выражен-ности антитромботического эффекта, так и недостаточной степени его эффекта, несмотря на регулярный прием и адекватные дозы пре-парата; последнее явление получило название «резистентность к антиагреганту». Оба откло-нения могут привести к серьезным клиничес-ким осложнениям -к кровотечению или, на-оборот, к тромбозу. В недостаточном эффекте препарата могут быть виноваты и генетически обусловленные нарушения метаболизма от-дельных препаратов на уровне цитохромов

show abstract

2012 Update to The Society of Thoracic Surgeons Guideline on Use of Antiplatelet Drugs in Patients Having Cardiac and Noncardiac Operations

Cited by 262 publications

References 213 publications

Safety of Preoperative Use of Ticagrelor With or Without Aspirin Compared With Aspirin Alone in Patients With Acute Coronary Syndromes Undergoing Coronary Artery Bypass Grafting

Safety of Preoperative Use of Ticagrelor With or Without Aspirin Compared With Aspirin Alone in Patients With Acute Coronary Syndromes Undergoing Coronary Artery Bypass Grafting

2014 ESC/ESA Guidelines on Non-cardiac Surgery: Cardiovascular Assessment and Management

Individual Approach to Patients With Indication for Antiplatelet Therapy. What to Rely on in Choosing the Therapy?

Contact Info

Product

Resources

About