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Management of Antiplatelet Agents in the Perioperative Setting

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Abstract

Management of antiplatelet agents in the perioperative setting is a common clinical challenge. Although discontinuation of aspirin therapy in patients who are taking aspirin for primary or secondary prevention is common, premature cessation of antiplatelet therapy in a patient with a prior drug-eluting stent is the single most important predictor of stent thrombosis, which carries a high morbidity and mortality. Therefore, these patients should ideally continue their antiplatelet therapy throughout surgery. However, this approach to reducing the risk of stent thrombosis must be counterbalanced by the increased risk of surgical bleeding. Multiple factors require evaluation to appropriately balance the risk of stent thrombosis against the risk of surgical bleeding. These include the type and timing of surgery, type and location of coronary stents if present, extent of coronary artery disease, and patient-specific risk factors. In general, for patients with coronary stents, all elective surgeries should be delayed until dual antiplatelet therapy is no longer crucial. Most surgical procedures may be performed on aspirin with acceptable risk of bleeding.

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Authors and Affiliations

  1. Department of Cardiology, McGill University Health Center/McGill Univesrity, 687 Pine Ave, West, Montreal, QC, H3A 1A1, Canada

    Ali O. Abualsaud MBBS

  2. Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital/McGill University, 3755 Cote-Ste-Catherine Rd/Room H-421, Montreal, QC, H3T 1E2, Canada

    Mark J. Eisenberg MD, MPH, FACC, FAHA

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  1. Ali O. Abualsaud MBBS
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  2. Mark J. Eisenberg MD, MPH, FACC, FAHA
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Correspondence to Mark J. Eisenberg MD, MPH, FACC, FAHA .

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Editors and Affiliations

  1. Division of Cardiology, Department of Medicine,, Stony Brook University, School of Medicine,, Stony Brook, USA

    Kathleen Stergiopoulos

  2. Division of Cardiology, Stony Brook University, Stony Brook, New York, USA

    David L. Brown

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Abualsaud, A.O., Eisenberg, M.J. (2014). Management of Antiplatelet Agents in the Perioperative Setting. In: Stergiopoulos, K., Brown, D. (eds) Evidence-Based Cardiology Consult. Springer, London. https://doi.org/10.1007/978-1-4471-4441-0_37

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  • DOI: https://doi.org/10.1007/978-1-4471-4441-0_37

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