Peri-operative management of antiplatelet therapy in patients with coronary artery disease

Wolfgang Korte; Marco Cattaneo; Pierre-Guy Chassot; Sabine Eichinger; Christian von Heymann; Niklaus Hofmann; Hans Rickli; Michael Spannagl; Bernhard Ziegler; Freek Verheugt; Kurt Huber

doi:10.1160/TH10-04-0217

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2011; 105(05): 743-749
DOI: 10.1160/TH10-04-0217

Consensus Document

Schattauer GmbH

Peri-operative management of antiplatelet therapy in patients with coronary artery disease

Joint position paper by members of the working group on Perioperative Haemostasis of the Society on Thrombosis and Haemostasis Research (GTH), the working group on Perioperative Coagulation of the Austrian Society for Anesthesiology, Resuscitation and Intensive Care (ÖGARI) and the Working Group Thrombosis of the European Society for Cardiology (ESC)

Wolfgang Korte

¹Center for Laboratory Medicine, Kantonsspital St. Gallen, Switzerland

,

Marco Cattaneo

²Medicina 3, Ospedale San Paolo, Department of Medicine, Surgery and Dentistry, Università degli Studi di Milano, Milan, Italy

,

Pierre-Guy Chassot

³Departement of Anesthesiology, University Hospital Lausanne, Switzerland

,

Sabine Eichinger

⁴Department of Medicine I, Division of Hematology, Medical University of Vienna, Austria

,

Christian von Heymann

⁵Department of Anesthesiology and Intensive Care, Charité-Universitätsmedizin Berlin, Germany

,

Niklaus Hofmann

⁶Department of Anesthesiology, Diakonissen-Krankenhaus Salzburg, Austria

,

Hans Rickli

⁷Division of Cardiology, Kantonsspital St. Gallen, Switzerland

,

Michael Spannagl

⁸Division of Haemostaseology, University of Munich, Germany

,

Bernhard Ziegler

⁹Department of Anesthesiology, Landeskliniken Salzburg, Austria

,

Freek Verheugt

¹⁰Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands

,

Kurt Huber

¹¹3^rd Medical Department, Cardiology and Emergency Medicine, Wilhelminenspital, Vienna, Austria

› Author Affiliations

Abstract

Summary

An increasing number of patients suffering from cardiovascular disease, especially coronary artery disease (CAD), are treated with aspirin and/or clopidogrel for the prevention of major adverse events. Unfortunately, there are no specific, widely accepted recommendations for the perioperative management of patients receiving antiplatelet therapy. Therefore, members of the Perioperative Haemostasis Group of the Society on Thrombosis and Haemostasis Research (GTH), the Perioperative Coagulation Group of the Austrian Society for Anesthesiology, Reanimation and Intensive Care (ÖGARI) and the Working Group Thrombosis of the European Society of Cardiology (ESC) have created this consensus position paper to provide clear recommendations on the perioperative use of antiplatelet agents (specifically with semi-urgent and urgent surgery), strongly supporting a multidisciplinary approach to optimize the treatment of individual patients with coronary artery disease who need major cardiac and non-cardiac surgery. With planned surgery, drug eluting stents (DES) should not be used unless surgery can be delayed for ≥12 months after DES implantation. If surgery cannot be delayed, surgical revascularisation, bare-metal stents or pure balloon angioplasty should be considered. During ongoing antiplatelet therapy, elective surgery should be delayed for the recommended duration of treatment. In patients with semi-urgent surgery, the decision to prematurely stop one or both antiplatelet agents (at least 5 days pre-operatively) has to be taken after multidisciplinary consultation, evaluating the individual thrombotic and bleeding risk. Urgently needed surgery has to take place under full antiplatelet therapy despite the increased bleeding risk. A multidisciplinary approach for optimal antithrombotic and haemostatic patient management is thus mandatory.

Keywords

Antiplatelet agents - surgery - atherothrombosis - coronary syndrome - atherosclerosis

Full Text

References

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