The peri-operative management of anti-platelet therapy in elective, non-cardiac surgery

Alcock, R.; Naoum, Chris; Aliprandi-Costa, B.; Hillis, Graham S.; Brieger, David

doi:10.1016/j.ijcard.2011.12.096

Cited by 8 publications

(4 citation statements)

References 33 publications

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“…A single-centre study analysed 516 ASA-treated patients undergoing elective non-cardiac surgery: 289 patients had antiplatelet therapy stopped in the perioperative period. The decision to cease antiplatelet therapy, which occurred commonly, did not appear to be guided by perioperative cardiac risk stratification [ 16 ]. A Swedish study concluded that in high-risk patients undergoing non-cardiac surgery, perioperative aspirin reduced the risk of major adverse cardiac events without increasing bleeding complications [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Perioperative cardiovascular complications versus perioperative bleeding in consecutive patients with known cardiac disease undergoing non-cardiac surgery. Focus on antithrombotic medication. The PRAGUE-14 registry

et al. 2014

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BackgroundInterruption of antithrombotic treatment before surgery may prevent bleeding, but at the price of increasing cardiovascular complications. This prospective study analysed the impact of antithrombotic therapy interruption on outcomes in non-selected surgical patients with known cardiovascular disease (CVD).MethodsAll 1200 consecutive patients (age 74.2 ± 10.2 years) undergoing major non-cardiac surgery (37.4 % acute, 61.4 % elective) during a period of 2.5 years while having at least one CVD were enrolled. Details on medication, bleeding, cardiovascular complications and cause of death were registered.ResultsIn-hospital mortality was 3.9 % (versus 0.9 % mortality among 17,740 patients without CVD). Cardiovascular complications occurred in 91 (7.6 %) patients (with 37.4 % case fatality). Perioperative bleeding occurred in 160 (13.3 %) patients and was fatal in 2 (1.2 % case fatality). Multivariate analysis revealed age, preoperative anaemia, history of chronic heart failure, acute surgery and general anaesthesia predictive of cardiovascular complications. For bleeding complications multivariate analysis found warfarin use in the last 3 days, history of hypertension and general anaesthesia as independent predictive factors. Aspirin interruption before surgery was not predictive for either cardiovascular or for bleeding complications.ConclusionsPerioperative cardiovascular complications in these high-risk elderly all-comer surgical patients with known cardiovascular disease are relatively rare, but once they occur, the case fatality is high. Perioperative bleeding complications are more frequent, but their case fatality is extremely low. Patterns of interruption of chronic aspirin therapy before major non-cardiac surgery are not predictive for perioperative complications (neither cardiovascular, nor bleeding). Simple baseline clinical factors are better predictors of outcomes than antithrombotic drug interruption patterns.

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Section: Discussionmentioning

confidence: 99%

Perioperative cardiovascular complications versus perioperative bleeding in consecutive patients with known cardiac disease undergoing non-cardiac surgery. Focus on antithrombotic medication. The PRAGUE-14 registry

et al. 2014

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“…Therefore, dental surgeons are most of the times faced with dilemma whether to continue or stop such medications during extraction procedures. Murphy et al [1] in their survey, found that 90 % of the respondents which included general dental practioners stopped the antiplatelet agent prior to dental extractions and Alcock et al [2] found that the decision to cease anti-platelet therapy, which occurred in almost half of their study population, was not guided by peri-operative cardiac risk stratification. This shows that there is lack of awareness among dentists regarding management of patients on anti-platelet drugs [3].…”

Section: Introductionmentioning

confidence: 99%

Clinical Trial Evaluating the Risk of Thromboembolic Events During Dental Extractions

Sadhasivam

Bhushan

Chiang

et al. 2016

J. Maxillofac. Oral Surg.

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“…The frequency of thromboembolic events is estimated to be approximately 4% after non-cardiac surgery. 31 However, the risk of thromboembolic events is significantly higher among patients with the thromboprophylaxis, ranging from 10.9% to 18%. [32][33][34] This means that perioperative antithrombotic treatment has a greater impact on the incidence of PPH than other factors, but this treatment remains effective and appropriate for the prevention of postoperative thromboembolic complications after pancreatic surgery.…”

Section: Discussionmentioning

confidence: 99%

Postpancreatectomy Hemorrhage After Pancreatic Surgery in Patients Receiving Anticoagulation or Antiplatelet Agents

et al. 2015

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Background Postpancreatectomy hemorrhage (PPH) is a serious complication after pancreatic surgery. In this study, we evaluated PPH and thromboembolic complications after pancreatic surgery in patients with perioperative antithrombotic treatment. Methods Medical records of patients undergoing pancreatic surgery were reviewed retrospectively. Patients receiving thromboprophylaxis were given either bridging therapy with unfractionated heparin or continued on aspirin as perioperative antithrombotic treatment according to clinical indications and published recommendations. The International Study Group of Pancreatic Surgery definition of PPH was used. Risk factors associated with PPH were assessed by multivariate analysis. Results Thirty-four of 158 patients received perioperative antithrombotic treatment; this group had a significantly higher PPH rate (29.4% vs 6.5%, P = .001) and mortality (11.8% vs 2.4%, P = .039) than patients not receiving thromboprophylaxis. Multivariate analysis revealed that perioperative antithrombotic treatment was the only independent risk factor for PPH after pancreatic surgery (odds ratio 4.77; 95% CI 1.61-14.15; P = .005). Conclusions Perioperative antithrombotic treatment is an independent risk factor for PPH in patients undergoing pancreatic surgery, although this treatment effectively prevents postoperative thromboembolic events.

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The peri-operative management of anti-platelet therapy in elective, non-cardiac surgery

Cited by 8 publications

References 33 publications

Perioperative cardiovascular complications versus perioperative bleeding in consecutive patients with known cardiac disease undergoing non-cardiac surgery. Focus on antithrombotic medication. The PRAGUE-14 registry

Perioperative cardiovascular complications versus perioperative bleeding in consecutive patients with known cardiac disease undergoing non-cardiac surgery. Focus on antithrombotic medication. The PRAGUE-14 registry

Clinical Trial Evaluating the Risk of Thromboembolic Events During Dental Extractions

Postpancreatectomy Hemorrhage After Pancreatic Surgery in Patients Receiving Anticoagulation or Antiplatelet Agents

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