Management of antiplatelet therapy among patients on antiplatelet therapy for coronary or cerebrovascular disease or with prior percutaneous cardiac interventions undergoing elective surgery a systematic review

The perioperative management of antiplatelet therapy for patients with coronary stents remains unclear. This review was requested to assess the evidence for the following key questions: among patients on APT in conjunction with percutaneous coronary intervention (PCI) undergoing elective surgical pr...

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Main Author: Shekelle, Paul G.
Corporate Authors: United States Department of Veterans Affairs, Quality Enhancement Research Initiative (U.S.), West Los Angeles VA Medical Center Evidence-Based Synthesis Program Center
Format: eBook
Language:English
Published: Washington, DC Department of Veterans Affairs, Health Services Research & Development Service 2017, June 2017
Series:Evidence-based synthesis program
Subjects:
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Collection: National Center for Biotechnology Information - Collection details see MPG.ReNa
Summary:The perioperative management of antiplatelet therapy for patients with coronary stents remains unclear. This review was requested to assess the evidence for the following key questions: among patients on APT in conjunction with percutaneous coronary intervention (PCI) undergoing elective surgical procedures, including intraocular procedures, what are the benefits and harms of holding APT prior to surgery? How does benefit/risk vary by the timing of discontinuation? How does benefit/risk vary by type of surgical procedure, including intraocular procedures? How does benefit/risk vary by type of APT? How does benefit/risk vary by the timing of resuming APT? We conducted searches in PubMed, Web of Science, and Scopus from inception of each database to 12/17/2015. Thirteen observational studies reported the details of preoperative APT, perioperative APT management, and outcomes, in sufficient detail to assess their association. In general, within studies the bleeding outcomes were reported at higher rates than the MACE outcomes, timing of cessation, bridging, restarting therapy, and type of APT. Additionally, the varied range of invasiveness of the procedure, from skin excisions to major thoracic cases, contributes to the operative bleeding risk and MACE risk, yet many studies lacks sufficient detail to assess the impact of procedure on the outcomes. The results also suggest that clinical factors other than perioperative APT management may be in part responsible for MACE and bleeding outcomes. It is likely that a clinical trial of large size would be needed to more definitely provide evidence about this clinical decision
Physical Description:1 PDF file (iii, 46 pages) illustrations