TY - JOUR
T1 - Perioperative handling of antiplatelet drugs. A critical appraisal
AU - Di Minno, Matteo Nicola Dario
AU - Milone, Marco
AU - Mastronardi, Pasquale
AU - Ambrosino, Pasquale
AU - Di Minno, Alessandro
AU - Parolari, Alessandro
AU - Tremoli, Elena
AU - Prisco, Domenico
PY - 2013
Y1 - 2013
N2 - Because of more and more accurate cardiovascular prevention programs and the increasing mean age of the general population, the use of antiplatelet treatments is progressively increasing in the last years. Moreover, the widespread use of bare-metal stents (BMS) and drug-eluting stents (DES) significantly increased the number of subjects with the need of a combined antiplatelet treatment: Aspirin (ASA) and Clopidogrel (CLO). Within the first year after coronary stenting, approximately 5% of patients needs to undergo non-cardiac surgery interventions. In such patients, current guidelines suggest to stop antiplatelet agents 7-10 days before surgery to avoid the risk of increasing blood loss. On the other hand, it has been shown that the risk of surgical bleeding, if antiplatelet drugs are continued, is lower than that of coronary thrombosis if they are withdrawn. Thus, an accurate stratification of the population according to the thrombotic risk is needed and the bleeding and the thrombotic risk should be considered in parallel. Although a growing amount of recommendations have been released by several Societies, the perioperative handling of antiplatelet drugs still represents a major concern in clinical practice. In this review we report the major literature data about the perioperative handling of antiplatelet drugs. Moreover, in order to describe future treatment perspectives and to identify valuable alternatives to current antiplatelet agents in the perioperative period, pharmacokinetic and pharmacodynamic characteristics of newer antiplatelet drugs are reported and analyzed.
AB - Because of more and more accurate cardiovascular prevention programs and the increasing mean age of the general population, the use of antiplatelet treatments is progressively increasing in the last years. Moreover, the widespread use of bare-metal stents (BMS) and drug-eluting stents (DES) significantly increased the number of subjects with the need of a combined antiplatelet treatment: Aspirin (ASA) and Clopidogrel (CLO). Within the first year after coronary stenting, approximately 5% of patients needs to undergo non-cardiac surgery interventions. In such patients, current guidelines suggest to stop antiplatelet agents 7-10 days before surgery to avoid the risk of increasing blood loss. On the other hand, it has been shown that the risk of surgical bleeding, if antiplatelet drugs are continued, is lower than that of coronary thrombosis if they are withdrawn. Thus, an accurate stratification of the population according to the thrombotic risk is needed and the bleeding and the thrombotic risk should be considered in parallel. Although a growing amount of recommendations have been released by several Societies, the perioperative handling of antiplatelet drugs still represents a major concern in clinical practice. In this review we report the major literature data about the perioperative handling of antiplatelet drugs. Moreover, in order to describe future treatment perspectives and to identify valuable alternatives to current antiplatelet agents in the perioperative period, pharmacokinetic and pharmacodynamic characteristics of newer antiplatelet drugs are reported and analyzed.
KW - New antiplatelet drugs
KW - Perioperative management
KW - Thrombotic risk
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U2 - 10.2174/1389450111314080008
DO - 10.2174/1389450111314080008
M3 - Article
C2 - 23627916
AN - SCOPUS:84881328773
VL - 14
SP - 880
EP - 888
JO - Current Drug Targets
JF - Current Drug Targets
SN - 1389-4501
IS - 8
ER -