Evaluation of Feasible Timing of Elective Noncardiac Procedure after Antiplatelet Discontinuation in Patients Treated with Antiplatelet Agents

Joo, Min Sun; Ahn, Byung Moo; Kim, Hee Jun; Mun, Hee-Sun; Kang, Min Kyung; Choi, Seong Hoon; Park, Min Jeong; Song, Won Keun; Lee, Nam Ho; Cho, Jung Rae

doi:10.2310/jim.0000000000000070

Cited by 7 publications

(6 citation statements)

References 13 publications

(18 reference statements)

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“…According to the 2014 American College of Cardiology/American Heart Association guideline, initiation or continuation of ASA is not helpful in patients undergoing elective noncardiac noncarotid operation, except in patients who have had previous coronary artery stent, unless the risk of ischemic insults is higher than that of postoperative hemorrhage 8). A recent study using platelet functional assays demonstrated that the mean time for complete reversal of platelet reactivity is 2.6 days in patients who take low-dose ASA and 2.8 days in those who take clopidogrel 9). The authors recommended that the appropriate time for noncardiac procedures after stopping antiplatelet agents be less than 5 days 9)…”

Section: Discussionmentioning

confidence: 99%

The Effect of Preoperative Antiplatelet Therapy on Hemorrhagic Complications after Decompressive Craniectomy in Patients with Traumatic Brain Injury

Han

Koh

Choi

et al. 2016

Korean J Neurotrauma

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ObjectiveTraditionally, it is generally recommended that antiplatelet agent should be discontinued before surgery. However, decompressive craniectomy (DC) in patients with traumatic brain injury (TBI) is performed emergently in most cases. Therefore, DC cannot be delayed to the time when the effect of antiplatelet agent on bleeding tendency dissipates. In this study, we evaluated the effect of preinjury antiplatelet therapy on hemorrhagic complications after emergent DC in patients with TBI.MethodsWe retrospectively investigated patients with TBI who underwent emergent DC between 2006 and 2015. The patients were separated into two groups according to the use of preinjury antiplatelet agent: group 1 (patients taking antiplatelet agent) and group 2 (patients not taking antiplatelet agent). The rate of hemorrhagic complications (postoperative epidural or subdural hemorrhage, newly developed, or progression of preexisting contusion or intracerebral hemorrhage within the field of DC) and the rate of reoperation within 7 days after DC were compared between two groups.ResultsDuring the study period, DC was performed in 90 patients. Of them, 19 patients were taking antiplatelet agent before TBI. The rate of hemorrhagic complications was 52.6% (10/19) in group 1 and 46.5% (33/71) in group 2 (p=0.633). The rate of reoperation was 36.8% (7/19) in group 1 and 36.6% (26/71) in group 2 (p=0.986). No statistical difference was found between two groups.ConclusionPreinjury antiplatelet therapy did not influence the rate of hemorrhagic complications and reoperation after DC. Emergent DC in patients with TBI should not be delayed because of preinjury antiplatelet therapy.

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Section: Discussionmentioning

confidence: 99%

The Effect of Preoperative Antiplatelet Therapy on Hemorrhagic Complications after Decompressive Craniectomy in Patients with Traumatic Brain Injury

Han

Koh

Choi

et al. 2016

Korean J Neurotrauma

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“…Four veterinary studies (LOE 3, Fair) and 3 from human medicine (LOE 6, Good) provided evidence for this guideline. In patients receiving irreversible antiplatelet agents, a 24‐hour withdrawal time is unlikely to be different than not discontinuing the agent at all in patients at high risk for thrombosis and hence this guideline reflects as given in Section 5.2.…”

Section: Guidelinesmentioning

confidence: 96%

American College of Veterinary Emergency and Critical Care (ACVECC) Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE) guidelines: Small animal

Goggs

Blais

Brainard

et al. 2019

J Vet Emergen Crit Care

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Objectives: To systematically review available evidence and establish guidelines related to the risk of developing thrombosis and the management of small animals with antithrombotics. Design: Standardized, systematic evaluation of the literature (identified by searching Medline via PubMed and CAB abstracts) was carried out in 5 domains (Defining populations at risk; Defining rational therapeutic use; Defining evidence-based protocols; Refining and monitoring antithrombotic therapies; and Discontinuing antithrombotic therapies). Evidence evaluation was carried out using Population, Intervention, Comparison, Outcome generated within each domain questions to address specific aims. This was followed by categorization of relevant articles according to level of evidence and quality (Good, Fair, or Poor). Synthesis of these data led to the development of a series of statements. Consensus on the final guidelines was achieved via Delphi-style surveys.Draft recommendations were presented at 2 international veterinary conferences and made available for community assessment, review, and comment prior to final revisions and publication. Settings: Academic and referral veterinary medical centers.Results: Over 500 studies were reviewed in detail. Worksheets from all 5 domains generated 59 statements with 83 guideline recommendations that were refined during 3 rounds of Delphi surveys. A high degree of consensus was reached across all guideline recommendations. Conclusions:Overall, systematic evidence evaluations yielded more than 80 recommendations for the treatment of small animals with or at risk of developing thrombosis. Numerous significant knowledge gaps were highlighted by the evidence reviews undertaken, indicating the need for substantial additional research in this field. K E Y W O R D S ) for their dedicated contributions to this effort. We would also like to thank the members of the veterinary community who attended and contributed to the discussion of the guidelines during the 2018 EVECC Congress and IVECCS sessions and subsequently during the online open-comment stages. CONFLICT OF INTERESTThe authors declare that they have no conflicts of interest.

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“…Furthermore, two complications such as difficult hemostasis [13] and postoperative intracranial hemorrhage [14] contributed to the poor outcome in the TBI patients. Therefore, it was recommended that all APT should be stopped more than 5 days prior to neurosurgical operation [15]. However, these patients required an urgent decompressive craniectomy, which cannot be delayed to the time when the effect of antiplatelet drugs on hemorrhagic complications disappears.…”

Section: Discussionmentioning

confidence: 99%

Twist drill craniostomy for traumatic acute subdural hematoma in the elderly: case series and literature review

Huang

Sun²,

Xie

et al. 2019

Chin Neurosurg Jl

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Background: A large craniotomy is usually the first choice for removal of traumatic acute subdural hematoma (TASDH). To date, few studies have reported that TASDH could be successfully treated by twist drill craniostomy (TDC) alone or combined with instillation of urokinase. We aimed to define the TDC for the elderly with TASDH and performed literature review. Case presentation: A total of 7 TASDH patients, who were presented and treated by TDC in this retrospective study between January 2009 and May 2017, consisted of 5 men and 2 women, ranging in age from 65 to 89 (average, 78.9) years. The patients' baseline characteristics, including age, sex, medical history, received ventriculoperitoneal shunt for hydrocephalus or not, reason for avoiding or refusing large craniotomy, preoperative Glasgow Coma Scale (GCS), suffered from cerebral herniation or not, the location of TASDH, imaging characteristics of TASDH in CT scan, injury/surgery time interval, midline shift, preoperative neurologic deficit, operation time, and infusions of urokinase or not, were collected. The postoperative GCS, postoperative neurologic deficit, rebleeding or not, intracranial infection, and modified Rankin Scale (mRS) at 6 months after surgery were analyzed to access the safety and efficacy of evacuation with TDC. The results showed that the mean time interval from injury to TDC was 68.6 min (30-120 min). The mean distance of midline shift was 14.6 mm (10-20 mm). The preoperative GCS in all patients ranged from 4 to 13 (median, 9). The mean duration of the operation was 14.4 min (6-19 min). Postoperative CT scan showed that hematoma evacuation rate was more than 70% in all cases. There were no cases of acute rebleeding and intracranial infection after TDC. No cases presented with chronic SDH at the ipsilateral side within 6 months after being treated by TDC alone or combined with instillation of urokinase. Favorable outcomes were shown in all cases (mRS scores 0-2) at 6 months after surgery. Conclusions: TASDH in the elderly could be safely and effectively treated by TDC alone or combined with instillation of urokinase, which was a possible alternative for the elderly.

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Evaluation of Feasible Timing of Elective Noncardiac Procedure after Antiplatelet Discontinuation in Patients Treated with Antiplatelet Agents

Abstract: The feasible timing of NCP after discontinuation of APAs showed less than 5 days. VerifyNow is useful in the evaluation of antiplatelet reversal after discontinuation of APAs. .

Cited by 7 publications

References 13 publications

The Effect of Preoperative Antiplatelet Therapy on Hemorrhagic Complications after Decompressive Craniectomy in Patients with Traumatic Brain Injury

The Effect of Preoperative Antiplatelet Therapy on Hemorrhagic Complications after Decompressive Craniectomy in Patients with Traumatic Brain Injury

American College of Veterinary Emergency and Critical Care (ACVECC) Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE) guidelines: Small animal

Twist drill craniostomy for traumatic acute subdural hematoma in the elderly: case series and literature review

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