Perioperative management of antiplatelet agents in noncardiac surgery

Llau, Juan V.; Lopez-Forte, Cristina; Sapena, Luisa; Ferrandis, Raquel

doi:10.1097/eja.0b013e328324b79f

Cited by 43 publications

(32 citation statements)

References 35 publications

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“…31 Based on the present results, Aspirin should not be stopped for elective surgery in patients with history of EC-IC bypass, whenever possible.…”

Section: Discussionmentioning

confidence: 73%

Extracranial–intracranial bypass in atherosclerotic cerebrovascular disease: report of a single centre experience

Muroi¹,

Khan²,

Bellut³

et al. 2011

British Journal of Neurosurgery

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Despite the failure of the international extracranial-intracranial (EC-IC) bypass study in showing the benefit of bypass procedure for prevention of stroke recurrence, it has been regarded to be beneficial in a subgroup of well-selected patients with haemodynamic impairment. This report includes the EC-IC bypass experience of a single centre over a period of 14 years. All consecutive 72 patients with atherosclerotic occlusive cerebrovascular lesions associated with haemodynamic compromise treated by EC-IC bypass surgery were retrospectively reviewed. Pre-operatively, 61% of patients presented with minor stroke and the remaining 39% with recurrent transient ischemic attacks (TIAs) despite maximal medical therapy. Angiography revealed a unilateral internal carotid artery (ICA) stenosis/occlusion in 79%, bilateral ICA stenosis/occlusion in 15%, MCA stenosis/occlusion in 3% and other multiple vessel stenosis/occlusion in 3% of the cases. H(2)(15)O positron emission tomography (PET) or 99mTc-HMPAO SPECT with acetazolamide challenge was performed for haemodynamic evaluation of the cerebral blood flow (CBF). All the patients had impaired haemodynamics pre-operatively in terms of reduced regional cerebrovascular reserve capacity and rCBF. Standard STA-MCA bypass procedure was performed in all patients. A total of 68 patients with 82 bypasses were reviewed with a mean follow-up period of 34 months. Stroke recurrence took place in 10 patients (15%) resulting in an annual stroke risk of 5%. Improved cerebral haemodynamics was documented in 81% of revascularised hemispheres. Patients with unchanged or worse haemodynamic parameters had significantly more post-operative TIAs or strokes when compared to those with improved perfusion reserves (30% vs.5% of patients, p<0.05). In conclusion, EC-IC bypass procedure in selected patients with occlusive cerebrovascular lesions associated with haemodynamic impairment has revealed to be effective for prevention of further cerebral ischemia, when compared with a stroke risk rate of 15% reported to date in patients only under antiplatelet agents or anticoagulant therapy. Extracranial-intracranial Bypass in Atherosclerotic Cerebrovascular AbstractDespite the negative results of the international EC-IC bypass study, well-selected patients with haemodynamic impairment might benefit from the bypass procedure in terms of stroke prevention. This report is about a single centre experience in EC-IC bypass procedure. All patients with atherosclerotic occlusive cerebrovascular diseases treated by EC-IC bypass surgery were retrospectively reviewed.Preoperatively, 61% of patients presented with minor stroke and the remaining 39%

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“…31 Based on the present results, Aspirin should not be stopped for elective surgery in patients with history of EC-IC bypass, whenever possible.…”

Section: Discussionmentioning

confidence: 73%

Extracranial–intracranial bypass in atherosclerotic cerebrovascular disease: report of a single centre experience

Muroi¹,

Khan²,

Bellut³

et al. 2011

British Journal of Neurosurgery

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“…Conversely, clopidogrel treatment, e.g. via a drug-eluting stent, can contraindicate a pause and thus suggests postponement of the LP in other settings [17]. …”

Section: Discussionmentioning

confidence: 99%

Haemostasis and Safety Measures before Lumbar Puncture in the Haematology Ward: The Danish Routines

2014

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Background/Aims: Thrombocytopenia and the increasing use and variety of antithrombotic drugs is a challenge prior to lumbar puncture. This study examined the Danish haematology practice regarding drug pausation, assessment of haemostasis and whether fundoscopy is a routine safety measure. Methods: An online survey with questions pertaining to precautions of haemostasis and application of fundoscopy was sent by e-mail to all 12 haematology wards in Denmark. Results: Eleven sites participated. Five (45%) reported no pausation of antiplatelet drugs at all. The mean platelet limit prior to lumbar puncture was 50 × 10⁹/l (range 10-50 × 10⁹/l). Seven (64%) sites had an international normalised ratio limit of 1.5, and the remaining 4 had values between 1.0 and 2.5. Two (18%) reported occasional use of thromboelastography or platelet analysis to assess the bleeding risk. Fundoscopy is routinely performed in 4 (36%) departments. Conclusion: We report considerable variation in the routine handling of antithrombotics and thrombocytopenia in patients set for lumbar puncture in Danish haematology departments. The diversity may be explained by and related to different opinions in the literature. Common national guidelines are warranted and there is a need for studies to establish an evidence-based approach for the management of patients at risk of bleeding when lumbar puncture or another invasive procedure is indicated.

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“…[44] Nevertheless, there are many circumstances that are not clear yet and, in this situation, it is crucial that patients are treated with a multidisciplinary approach (anaesthesiologists, surgeons, cardiologists and hematologists). The approach remains individualistic and surgeons may prefer withdrawing antiplatelet agents for a period of 3 days to a week prior to surgery and restart over a period of few days to a week post surgery.…”

Section: Unique Clinical Situations and Decision Makingmentioning

confidence: 99%

Optimization of antiplatelet/antithrombotic therapy for secondary stroke prevention

Srivastava¹

2010

Ann Indian Acad Neurol

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Perioperative management of antiplatelet agents in noncardiac surgery

Cited by 43 publications

References 35 publications

Extracranial–intracranial bypass in atherosclerotic cerebrovascular disease: report of a single centre experience

Extracranial–intracranial bypass in atherosclerotic cerebrovascular disease: report of a single centre experience

Haemostasis and Safety Measures before Lumbar Puncture in the Haematology Ward: The Danish Routines

Optimization of antiplatelet/antithrombotic therapy for secondary stroke prevention

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