When and how to discontinue antiplatelet therapy

Antiplatelet agents reduce the risk of ischaemic events but increase the risk of bleeding. When cardiac patients on antiplatelet therapy require surgery or invasive diagnostic procedures, a decision must be made whether or not to discontinue antiplatelet therapy. Because there is little evidence from clinical trials that would aid in the formulation of comprehensive recommendations, the decision must be made on an individual basis. The patient’s inherent risk for bleeding, concomitant treatments that may increase this risk, the potential of the procedure to cause bleeding, and the patient’s risk for ischaemic events if antiplatelet therapy is stopped all must be considered. Some procedures carry a low risk of bleeding and can be carried out in most patients without discontinuing antiplatelet therapy, whereas others require close evaluation and risk stratification of the patient. Patients on antiplatelet therapy undergoing cardiac surgery, those with drug-eluting stents, and those on anticoagulation require particularly careful management. There is an urgent need for research into this complex clinical problem.