Impact of preoperative use of P2Y12 receptor inhibitors on clinical outcomes in cardiac and non-cardiac surgery: A systematic review and meta-analysis

Abstract

Preoperative exposure to clopidogrel on top of aspirin did not reduce the risk of MACE but was associated with increased risk of bleeding and mortality.

2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Di

“…The timing of noncardiac surgery in patients treated with coronary stent implantation involves consideration of: (1) the risk of stent thrombosis (particularly if DAPT needs to be interrupted); (2) the consequences of delaying the desired surgical procedure; and (3) increased the intra-and peri-procedural bleeding risk and the consequences of such bleeding if DAPT is continued 15,147,148 (Data Supplement 12) . DAPT significantly reduces the risk of stent thrombosis, 50,51,94,95,99 and discontinuation of DAPT in the weeks after stent implantation is one of the strongest risk factors for stent thrombosis, with the magnitude of risk and impact on mortality rate inversely proportional to the timing of occurrence after the procedure .…”

2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease

“…The timing of noncardiac surgery in patients treated with coronary stent implantation involves consideration of: (1) the risk of stent thrombosis (particularly if DAPT needs to be interrupted); (2) the consequences of delaying the desired surgical procedure; and (3) increased the intraand peri-procedural bleeding risk and the consequences of such bleeding if DAPT is continued 15,147,148 (Data Supplement 12). DAPT significantly reduces the risk of stent thrombosis, 50,51,94,95,99 and discontinuation of DAPT in the weeks after stent implantation is one of the strongest risk factors for stent thrombosis, with the magnitude of risk and impact on mortality rate inversely proportional to the timing of occurrence after the procedure.…”

2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS

“…205 Management of patients on DAPT who are referred for surgical procedures involves consideration of: (1) the risk of stent thrombosis (particularly if DAPT needs to be interrupted); (2) the consequences of delaying the surgical procedure; and (3) the increased intra-and periprocedural bleeding risk and possible consequences of such bleeding if DAPT is continued. [206][207][208] Given the complexity of these considerations, a multidisciplinary approach-involving interventional cardiologists, cardiologists, anaesthetists, haematologists, and surgeons-is required to determine the patient's risk for bleeding and thrombosis and to choose the best management strategy. 205,209 A practical classification of the bleeding risk associated with each type of non-cardiac surgery has been recently proposed by the Stent After Surgery group.…”