Management of peridural catheter removal during dual antiplatelet therapy after postoperative myocardial infarction and drug-eluting stent implantation, applying the "bridging therapy" concept

Mogavero, Tindaro; Pace, Rocco; Vetrugno, Luigi

doi:10.23736/s0375-9393.18.12906-3

Cited by 1 publication

(2 citation statements)

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“…Currently, 11 case reports are available describing successful management. The cases describe myocardial infarctions during or within 3 days after surgery 116,136–145 . Key factors to successful management is an interdisciplinary approach and measures of platelet and plasma function.…”

Section: Discussionmentioning

confidence: 99%

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Regional anaesthesia in patients on antithrombotic drugs

Kietaibl

Ferrandis

Godiér

et al. 2022

European Journal of Anaesthesiology

119

103

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BACKGROUND Bleeding is a potential complication after neuraxial and peripheral nerve blocks. The risk is increased in patients on antiplatelet and anticoagulant drugs. This joint guideline from the European Society of Anaesthesiology and Intensive Care and the European Society of Regional Anaesthesia aims to provide an evidence-based set of recommendations and suggestions on how to reduce the risk of antithrombotic drug-induced haematoma formation related to the practice of regional anaesthesia and analgesia. DESIGN A systematic literature search was performed, examining seven drug comparators and 10 types of clinical intervention with the outcome being peripheral and neuraxial haematoma. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for assessing the methodological quality of the included studies and for formulating recommendations. A Delphi process was used to prepare a clinical practice guideline. RESULTS Clinical studies were limited in number and quality and the certainty of evidence was assessed to be GRADE C throughout. Forty clinical practice statements were formulated. Using the Delphi-process, strong consensus (>90% agreement) was achieved in 57.5% of recommendations and consensus (75 to 90% agreement) in 42.5%. DISCUSSION Specific time intervals should be observed concerning the adminstration of antithrombotic drugs both prior to, and after, neuraxial procedures or those peripheral nerve blocks with higher bleeding risk (deep, noncompressible). These time intervals vary according to the type and dose of anticoagulant drugs, renal function and whether a traumatic puncture has occured. Drug measurements may be used to guide certain time intervals, whilst specific reversal for vitamin K antagonists and dabigatran may also influence these. Ultrasound guidance, drug combinations and bleeding risk scores do not modify the time intervals. In peripheral nerve blocks with low bleeding risk (superficial, compressible), these time intervals do not apply. CONCLUSION In patients taking antiplatelet or anticoagulant medications, practitioners must consider the bleeding risk both before and after nerve blockade and during insertion or removal of a catheter. Healthcare teams managing such patients must be aware of the risk and be competent in detecting and managing any possible haematomas.

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Section: Discussionmentioning

confidence: 99%

“…100 mg) and replace the second platelet inhibitor with the short acting tirofiban or cangrelor as a bridge. Tirofiban can be stopped 8 h before catheter removal 141,147 . Cangrelor can be stopped 3 h before catheter removal 147 …”

Section: Discussionmentioning

confidence: 99%