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July 24, 2007British Journal of AnaesthesiaOpen Access

Perioperative antiplatelet therapy: the case for continuing therapy in patients at risk of myocardial infarction

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Why the study?

Does continuing antiplatelet therapy compared to interruption improve the balance of myocardial ischemia and bleeding in patients at risk of MI undergoing non-cardiac surgery?

Population

Patients at risk of myocardial infarction undergoing non-cardiac surgery

Comparison

Continuing antiplatelet therapy throughout… vs Interruption of antiplatelet therapy

Design

Review

Authors

PCP.-G. ChassotUniversity of LausanneADAlain DelabaysHôpital de MorgesDSDonat R. SpahnCross-Cutting Cardiology

Discussion

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Implication

Supports continuing aspirin perioperatively to minimize thrombosis risk; leaves open optimal clopidogrel timing in stented patients.

Structured PICO

Does continuing antiplatelet therapy compared to interruption improve the balance of myocardial ischemia and bleeding in patients at risk of MI undergoing non-cardiac surgery?

P
Population
Patients at risk of myocardial infarction (including those on secondary prevention and with bare metal or drug-eluting coronary stents) undergoing non-cardiac surgery
I
Intervention
Continuing antiplatelet therapy (aspirin, clopidogrel) throughout surgery or using a therapeutic bridge with shorter-acting antiplatelet drugs
C
Comparator
Interruption of antiplatelet therapy (e.g., 10 days before surgery)
O
Outcome
Balance of risk of myocardial ischaemia and death compared with surgical bleeding

Continuing antiplatelet therapy during non-cardiac surgery is recommended for patients at high coronary risk to prevent thrombosis, as this risk outweighs surgical bleeding risks in most cases.

Limitations

  • Large prospective studies with a high degree of evidence are still lacking on different antiplatelet regimens during non-cardiac surgery

Cite This Study

Chassot et al. (2007) studied this question.

synapsesocial.com/papers/6a6fc3b975498292b709268dhttps://doi.org/10.1093/bja/aem209

Topics

Dual antiplatelet therapy
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Adverse Cardiac Outcomes After Noncardiac Surgery in Patients with Prior Percutaneous Transluminal Coronary Angioplasty1999 · 149 citations
  2. 2Adverse Cardiac Outcomes After Noncardiac Surgery in Patients with Prior Percutaneous Transluminal Coronary Angioplasty1999 · 105 citations
  3. 3Major noncardiac surgery following coronary stenting: When is it safe to operate?2004 · 208 citations
  4. 4Clopidogrel and Aspirin versus Aspirin Alone for the Prevention of Atherothrombotic Events2006 · 2,837 citations
  5. 5Strength of evidence for perioperative use of statins to reduce cardiovascular risk: systematic review of controlled studies2006 · 166 citations