Endoscopic Sinus Surgery in Patients Receiving Anticoagulant or Antiplatelet Therapy

Sargi, Zoukaa; Casiano, Roy

doi:10.2500/ajr.2007.21.3019

Cited by 13 publications

(8 citation statements)

References 9 publications

(13 reference statements)

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“…In the otolaryngology literature, a case control study of sinus surgery patients found no increased blood loss in patients on baseline antithrombotic therapy. However, all patients in this study had therapy stopped at least 2 weeks prior to surgery, thereby eliminating any therapeutic effect at the time of surgery …”

Section: Discussionmentioning

confidence: 99%

Antiplatelet and anticoagulation therapy in microlaryngeal surgery

et al. 2013

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Section: Discussionmentioning

confidence: 99%

Antiplatelet and anticoagulation therapy in microlaryngeal surgery

et al. 2013

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“…Antibiotics are commonly used pre‐operatively to decrease infection and inflammation, although there are no trials that show whether they have an effect on surgical conditions or blood loss. Cessation of anticoagulation and antiplatelet medication is recommended, 17 but the risks of stopping these medications must be carefully considered 18–20 . Particular care is required in the setting of coronary stenting and the cessation of antiplatelet medications 18–22 and consultation with cardiology is recommended before scheduling surgery or ceasing antiplatelet medications 18–22 .…”

mentioning

confidence: 99%

Anaesthesia for endoscopic sinus surgery

Baker

2010

Acta Anaesthesiol Scand

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Endoscopic sinus surgery is commonly performed and has a low risk of major complications. Intraoperative bleeding impairs surgical conditions and increases the risk of complications. Remifentanil appears to produce better surgical conditions than other opioid analgesics, and total intravenous anaesthesia with propofol may provide superior conditions to a volatile-based technique. Moderate hypotension with intraoperative beta blockade is associated with better operating conditions than when vasodilating agents are used. Tight control of CO(2) does not affect the surgical view. The use of a laryngeal mask may be associated with improved surgical conditions and a smoother emergence. It provides airway protection equivalent to that provided by an endotracheal tube in well-selected patients, but offers less protection from gastric regurgitation. Post-operatively, multimodal oral analgesia provides good pain relief, while long-acting local anaesthetics have been shown not to improve analgesia.

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“…The authors concluded that stopping anticoagulation or antiplatelet therapy is mandatory before the surgery, but the medication could be resumed in the early postoperative period without increasing the risk for bleeding. 16 Di Girolamo et al conducted a retrospective chart review in 110 hematologic patients with rhinosinusitis. Seventy one percent of the patients had severe thrombocytopenia (platelet count <50 000) and the remaining had mild to moderate thrombocytopenia except for two patients without thrombocytopenia.…”

Section: Discussionmentioning

confidence: 99%

“In-Office Balloon Sinus Ostial Dilation with Concurrent Antiplatelet and Anticoagulant Therapy for Chronic Rhinosinusitis without Nasal Polyps”

Higgins

Öcal

Adams

et al. 2019

Ann Otol Rhinol Laryngol

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Objective: Functional endoscopic sinus surgery (FESS) and balloon sinus ostial dilation (BSD) are well-recognized minimally invasive surgical treatments for chronic rhinosinusitis without nasal polyps (CRSsNP) refractory symptoms to medical therapy. Patients on antiplatelet and anticoagulant therapies (AAT) usually are recommended to discontinue their medications around the period of endoscopic sinus surgery. The goal of this study is to assess the clinical experience of BSD in CRSsNP patients with concurrent anticoagulant or antiplatelet therapy. Methods: A review of prospectively-collected clinical data from October 2012 to March 2017 were used to perform a cohort study of subjects with CRSsNP who met criteria for surgical intervention while on antiplatelet and anticoagulant therapy. Data were collected on demographics, details of the procedures, type of AAT used, pre- and postoperative 22-item Sino-Nasal Outcome Test (SNOT-22) scores, and complications. Results: Thirty-five patients underwent in-office BSD while on antiplatelet and/or anticoagulant therapy. The mean difference in pre- and postoperative SNOT-22 scores of 9.9 (SD 14.4, P < .001) was both statistically significant and exceeded the minimal clinically important difference of 8.9. Absorbable nasal packing was used for persistent bleeding immediately post-procedure in two patients. Intraoperative bleeding was associated with aspirin 325 mg and warfarin. FESS was required for further management of chronic sinusitis in four patients after anticoagulant/antiplatelet therapy could be discontinued. There were no systemic complications. None of the patients experienced significant bleeding events postoperatively after leaving the office. Conclusion: In-office BSD appears to be a safe alternative to endoscopic sinus surgery in select patients who cannot discontinue antiplatelet and anticoagulant therapy. Levels of Evidence: IV

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Endoscopic Sinus Surgery in Patients Receiving Anticoagulant or Antiplatelet Therapy

Cited by 13 publications

References 9 publications

Antiplatelet and anticoagulation therapy in microlaryngeal surgery

Antiplatelet and anticoagulation therapy in microlaryngeal surgery

Anaesthesia for endoscopic sinus surgery

“In-Office Balloon Sinus Ostial Dilation with Concurrent Antiplatelet and Anticoagulant Therapy for Chronic Rhinosinusitis without Nasal Polyps”

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