2012 Update to The Society of Thoracic Surgeons Guideline on Use of Antiplatelet Drugs in Patients Having Cardiac and Noncardiac Operations

Division of Cardiovascular and Thoracic Surgery, University of Kentucky, Lexington, Kentucky. Electronic address: .
The Annals of thoracic surgery (Impact Factor: 3.85). 11/2012; 94(5):1761-81. DOI: 10.1016/j.athoracsur.2012.07.086
Source: PubMed
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Available from: Thomas Brett Reece, Mar 08, 2015
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    • "No superiority of one platelet reactivity test over the other for risk stratification of bleeding can be established. The Society of Thoracic Surgeons has recommended platelet reactivity testing as a tool to manage perioperative antiplatelet therapy in their guidelines.[7]In patients on dual antiplatelet therapy in need of urgent operations, bleeding risk estimates based on platelet reactivity testing should be used to decide upon surgical delay rather than the arbitrary use of a specific period of time (class IIa recommendation). "
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    ABSTRACT: Many patients are treated with platelet inhibitors such as aspirin and clopidogrel for prevention of thrombotic cardiovascular events. However, the inhibitory effect of antiplatelet therapy is variable between patients; in some, the platelets are hardly inhibited, while in others, the platelets are excessively inhibited. The newer and more potent platelet inhibitors, prasugrel and ticagrelor, often lead to low platelet reactivity, which potentially leads to bleeding events. Preoperative measurement of platelet reactivity in patients receiving platelet inhibitors who undergo cardiac surgery, could be useful to identify those with low platelet reactivity and thus have an increased risk of bleeding during or after surgery. In this review, we discuss the most commonly used platelet inhibitors and platelet function tests. Furthermore, we will provide an overview of the evidence for the prediction of post-operative bleeding at the operation site with preoperative platelet reactivity testing in patients undergoing cardiac surgery.
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    • "The current practice is to withhold antiplatelet therapy for up to a week before procedures associated with a high risk of bleeding [7]. However, in patients requiring urgent operations or bleeding excessively , current guidelines suggest platelet transfusions may be reasonable [7]. Although supplementation with active platelets has been shown to be effective in vitro to reverse the effect of aspirin and the P2Y12 inhibitors clopidogrel and prasugrel [8] [9] [10] [11] [12], it is unclear whether this strategy will be efficacious in the context of triple antiplatelet therapy with concomitant vorapaxar. "

    Full-text · Article · Nov 2015 · Thrombosis Research
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    • "For patients who receive DAPT, the decision to defer the operation according to PFT results is more reasonabl6e than making a decision on the operation day according to the period of drug withdrawal. The optimal value of continuing aspirin alone or DAPT to prevent stent thrombosis or other ischemic events during cardiac and non-cardiac surgery is uncertain because of the lack of prospective trials [14] [15] [16]. The risk of bleeding is likely to be higher with DAPT than with aspirin alone or no antiplatelet therapy, but the magnitude of the increase is uncertain. "

    Full-text · Article · Jun 2015 · Thrombosis Research
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