The evaluation of clopidogrel use in perioperative general surgery patients: a prospective randomized controlled trial

Chu, Edward; Chernoguz, Artur; Divino, Celia M.

doi:10.1016/j.amjsurg.2015.05.036

Cited by 33 publications

(17 citation statements)

References 30 publications

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“…29 Level II evidence from a nonblinded clinical trial also failed to demonstrate a difference in blood loss, transfusion rate, or complication rate between patients taking clopidogrel and controls. 30 Because of this, as well as the presence of inconsistency among guidelines on the necessity of perioperative discontinuation of antiplatelet therapy, we believe it is safe to continue patients on antiplatelet therapy prior to spine surgery. However, for those desiring to minimize the risk of massive intraoperative blood loss, the recommended discontinuation time frames can be found in Table 1.…”

Section: Antiplatelet Agentsmentioning

confidence: 99%

Minimizing Blood Loss in Spine Surgery

Mikhail

Pennington

Arnold

et al. 2020

Global Spine Journal

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Study Design: Broad narrative review. Objective: To review and summarize the current literature on guidelines, outcomes, techniques and indications surrounding multiple modalities of minimizing blood loss in spine surgery. Methods: A thorough review of peer-reviewed literature was performed on the guidelines, outcomes, techniques, and indications for multiple modalities of minimizing blood loss in spine surgery. Results: There is a large body of literature that provides a consensus on guidelines regarding the appropriate timing of discontinuation of anticoagulation, aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and herbal supplements prior to surgery. Additionally, there is a more heterogenous discussion the utility of preoperative autologous blood donation facilitated by erythropoietin and iron supplementation for healthy patients slated for procedures with high anticipated blood loss and for whom allogeneic transfusion is likely. Intraoperative maneuvers available to minimize blood loss include positioning and maintaining normothermia. Tranexamic acid (TXA), bipolar sealer electrocautery, and topical hemostatic agents, and hypotensive anesthesia (mean arterial pressure (MAP) <65 mm Hg) should be strongly considered in cases with larger exposures and higher anticipated blood loss. There is strong level 1 evidence for the use of TXA in spine surgery as it reduces the overall blood loss and transfusion requirements. Conclusion: As the volume and complexity of spinal procedures rise, intraoperative blood loss management has become a pivotal topic of research within the field. There are many tools for minimizing blood loss in patients undergoing spine surgery. The current literature supports combining techniques to use a cost- effective multimodal approach to minimize blood loss in the perioperative period.

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Section: Antiplatelet Agentsmentioning

confidence: 99%

Minimizing Blood Loss in Spine Surgery

Mikhail

Pennington

Arnold

et al. 2020

Global Spine Journal

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“…No veterinary studies specifically addressed the relevant PICO question and hence multiple studies from human medicine (LOE 6, Fair) were extrapolated to generate this guideline . The guideline represents a balance of the increased risk of thrombosis associated with drug discontinuation in patients with high‐risk conditions or where multiple risk factors exist compared to the perceived lower risk of surgical hemorrhage that may result from ongoing platelet inhibition of hemorrhage .…”

Section: Guidelinesmentioning

confidence: 99%

“…No veterinary studies specifically addressed the relevant PICO question and hence multiple studies from human medicine (LOE 6, Good) were extrapolated to generate this guideline . Patients at high risk of thrombosis are considered more likely to suffer consequences from thrombosis following discontinuation of heparin therapy than they are to suffer morbidity or mortality from procedure related hemorrhage .…”

Section: Guidelinesmentioning

confidence: 99%

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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“…We identified one RCT that met most of our inclusion criteria [ 18 ]. This study of NCS in a USA academic setting randomized patients to continue or stop perioperative clopidogrel.…”

Section: Resultsmentioning

confidence: 99%

Perioperative management of antiplatelet therapy in patients undergoing non-cardiac surgery following coronary stent placement: a systematic review

et al. 2018

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BackgroundThe correct perioperative management of antiplatelet therapy (APT) in patients undergoing non-cardiac surgery (NCS) is often debated by clinicians. American College of Cardiology (ACC) and American Heart Association (AHA) guidelines recommend postponing elective NCS at least 3 months after stent implantation. Regardless of the timing of surgery, ACC/AHA guidelines recommend continuing at least ASA throughout the perioperative period and ideally continuing dual APT (DAPT) therapy “unless surgery demands discontinuation.” The objective of this review was to ascertain the risks and benefits of APT in the perioperative period, to assess how these risks and benefits vary by APT management, and the significance of length of time since stent implantation before operative intervention.MethodsPubMed, Web of Science, and Scopus were searched from inception through October 2017. Articles were included if patients were post PCI with stent placement (bare metal [BMS] or drug eluting [DES]), underwent elective NCS, and had rates of major adverse cardiac events (MACE) or bleeding events associated with pre and perioperative APT therapy.ResultsOf 4882 screened articles, we included 16 studies in the review (1 randomized controlled trial and 15 observational studies). Studies were small (< 50: n = 5, 51–150: n = 5, >150: n = 6). All studies included DES with 7 of 16 also including BMS. Average time from stent to NCS was variable (< 6 months: n = 3, 6–12 months: n = 1, > 12 months: n = 6). At least six different APT strategies were described. Six studies further utilized bridging protocols using three different pharmacologic agents. Studies typically included multiple surgical fields with varying degrees of invasiveness. Across all APT strategies, rates of MACE/bleeding ranged from 0 to 21% and 0 to 22%. There was no visible trend in MACE/bleeding rates within a given APT strategy. Stratifying the articles by type of surgery, timing of discontinuation of APT therapy, bridging vs. no bridging, and time since stent placement did not help explain the heterogeneity.ConclusionsEvidence regarding perioperative APT management in patients with cardiac stents undergoing NCS is insufficient to guide practice. Other clinical factors may have a greater impact than perioperative APT management on MACE and bleeding events.Systematic review registrationPROSPERO CRD42016036607Electronic supplementary materialThe online version of this article (10.1186/s13643-017-0635-z) contains supplementary material, which is available to authorized users.

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The evaluation of clopidogrel use in perioperative general surgery patients: a prospective randomized controlled trial

Cited by 33 publications

References 30 publications

Minimizing Blood Loss in Spine Surgery

Minimizing Blood Loss in Spine Surgery

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

Perioperative management of antiplatelet therapy in patients undergoing non-cardiac surgery following coronary stent placement: a systematic review

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