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.

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.

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.

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.

Bleeding after cardiac surgery correlates with morbidity and mortality. The aim of this study was to determine the influence of antiplatelet therapy on bleeding and transfusion rates in coronary artery bypass grafting.

Forty patients receiving aspirin and/or clopidogrel/ticlopidine within 7 days prior to surgery were retrospectively compared to 40 control patients lacking antiplatelet therapy for at least 8 preoperative days. Blood loss was assessed as chest-tube drainage during the first 12 h after surgery. Units transfused were recorded intraoperatively and during stay in the intensive care unit.

Both groups were comparable for pre- and intraoperative data. Irrespective of single or combined antiplatelet therapy, treated patients demonstrated lower fractions of the creatine-kinase isoenzyme MB (5.8 ± 3.1 vs. 8.2 ± 4.1%; P = 0.004) and infarction rates (0 vs. 3; P = 0.240) than control patients, but had significantly more haemorrhages (940 ± 861 mL vs. 412 ± 590 mL; P = 0.002) and transfusion requirements (red cells: 4.5 ± 4.9 vs. 1.5 ± 2.3, plasma: 4.9 ± 6.4 vs. 1.3 ± 2.5, platelets: 1.5 ± 1.3 vs. 0.1 ± 0.2; all P ⩽ 0.001). The differences to control patients were more pronounced for only short antiplatelet therapy free intervals or ongoing antiplatelet therapy (P⩽2 days ⩽ 0.019). For antiplatelet therapy free intervals longer than 2 days, bleeding and transfusion rates (except for platelets) were nonsignificantly higher as compared to control patients (P ⩾ 0.058).

To overcome increased blood loss and transfusion rates, antiplatelet therapy should be discontinued for at least 2 days before elective coronary surgery. Whether patients at high risk for myocardial infarction might benefit from ongoing antiplatelet therapy remains to be investigated.