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Antiplatelet drugs in elective ENT surgery

Published online by Cambridge University Press:  17 July 2012

J R Savage*
Affiliation:
ENT Department, University of Sherbrooke, Quebec, Canada
A Parmar
Affiliation:
Otolaryngology Department, Gloucestershire Royal Hospital, Gloucester, UK
P J Robinson
Affiliation:
Otolaryngology Department, Southmead and Bristol Royal Children's Hospitals, Bristol, UK
*
Address for correspondence: Dr Julian Savage, Service d'ORL, CHUS – Hôtel-Dieu, 580 Rue Bowen Sud, Sherbrooke, Quebec J1G 2E8, Canada Fax: +1 819 564 5449 E-mail: [email protected]

Abstract

Introduction:

Oral antiplatelet drugs are increasingly being encountered in patients scheduled for elective ENT surgery. Their pre-operative cessation can have potentially serious complications in some patients, particularly those with intracoronary stents.

Methods:

In order to gain an impression of current peri-operative management of patients taking antiplatelet drugs, an online survey was distributed to the Expert Panel of ENT UK, the British Association of Otolaryngologists Head and Neck Surgeons, between 13 January and 15 February 2011.

Results:

Three hundred and three members were contacted. The response rate was 55 per cent (167 replies); 78 per cent of respondents were consultants. Results are presented in the main text.

Conclusion and recommendations:

Patients can be categorised as high or low risk, depending on their indication for taking antiplatelet drugs. Recommendations taken from the literature are given on how best to manage these two groups.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited 2012

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References

1Pope, L, Hobbs, C. Epistaxis: an update on current management. Postgrad Med J 2005;81:309–14CrossRefGoogle ScholarPubMed
2Alwitry, A, King, AJ, Vernon, SA. Anticoagulation therapy in glaucoma surgery. Graefes Arch Clin Exp Ophthalmol 2008;246:891–6Google Scholar
3Madan, G.A., Madan, S, Madan, G, Madan, AD. Minor oral surgery without stopping daily low-dose aspirin therapy: a study of 51 patients. J Oral Maxillofac Surg 2005;63:1262–5CrossRefGoogle ScholarPubMed
4Mukerji, G, Munasinghe, I, Raza, A. A survey of the peri-operative management of urological patients on clopidogrel. Ann R Coll Surg Engl 2009;91:313–20CrossRefGoogle ScholarPubMed
5Servin, F. Low-dose aspirin and clopidogrel: how to act in patients scheduled for day surgery. Curr Opin Anaesthesiol 2007;20:531–4Google Scholar
6Antithrombotic Trialists' Collaboration. Collaborative meta-analysis of randomized trials of antiplatelet therapy for prevention of death, myocardial infarction and stroke in high risk patients. BMJ 2002;324:7186CrossRefGoogle Scholar
7Patrono, C, Baigent, C, Hirsh, J, Roth, G, American College of Chest Physicians. Antiplatelet drugs: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest 2008;133(suppl):199233SCrossRefGoogle ScholarPubMed
8Patrono, C, Coller, B, FitzGerald, G, Hirsch, J, Roth, G. Platelet-active drugs: the relationships among dose, effectiveness, and side effects: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126(suppl):23464SGoogle Scholar
9Webber, A, Braun, M, Hohfeld, T, Schiwippert, B, Tschope, D, Schror, K. Recovery of platelet function after discontinuation of clopidogrel treatment in healthy volunteers. Br J Clin Pharmacol 2001;52:333–6CrossRefGoogle Scholar
10Bhala, N, Taggar, JS, Rajasekhar, P, Banerjee, A. Anticipating and managing bleeding complications in patients with coronary stents who are receiving dual antiplatelet treatment. BMJ 2011;343:d4264CrossRefGoogle ScholarPubMed
11Chassot, P, Delabays, A, Spahn, D. Perioperative antiplatelet therapy: the case for continuing therapy in patients at risk of myocardial infarction. Br J Anaesth 2007;99:316–28Google Scholar
12Naidu, S. Bare-metal versus drug-coated intracoronary stents in clinical practice: are there guidleines? Vascular Disease Management 2009;6:136–44Google Scholar
13Douketis, J, Berger, P, Dunn, A, Jaffer, A, Spyropoulos, A, Becker, R et al. The perioperative management of antithrombotic therapy – American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest 2008;133(suppl):299339SCrossRefGoogle ScholarPubMed
14Grines, C, Bonow, R, Casey, D Jr, Gardner, T, Lockhart, P, Moliterno, D et al. Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents. A science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons and American Dental Association, with representation from the American College of Physicians. J Am Dent Assoc 2007;138:652–5Google Scholar
15Burger, W, Chemnitus, J-M, Kneissl, G, Rücker, G. Low-dose aspirin for secondary cardiovascular prevention – cardiovascular risks after its perioperative withdrawal versus bleeding risks with its continuation – review and meta-analysis. J Intern Med 2005;257:399414CrossRefGoogle ScholarPubMed
16Nwachuku, I, Jones, M, Clough, T. Clopidogrel: is a surgical delay necessary in fractured neck of femur? Ann R Coll Surg Engl 2011;93:310–13CrossRefGoogle ScholarPubMed
17Vilahur, G, Choi, B, Zafar, M, Viles-Gonzalez, J, Vorchheimer, D, Fuster, V et al. Normalization of platelet reactivity in clopidogrel-treated subjects. J Thromb Haemost 2007;5:8290Google Scholar
18Neuner, M, Davis, J. How to reverse an antithrombotic agent. Emergency Medicine 2009;41:8Google Scholar