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180702 r ||| eng |
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|a Shekelle, Paul G.
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|a Management of antiplatelet therapy among patients on antiplatelet therapy for coronary or cerebrovascular disease or with prior percutaneous cardiac interventions undergoing elective surgery
|h Elektronische Ressource
|b a systematic review
|c prepared for Department of Veterans Affairs, Veterans Health Administration, Quality Enhancement Research Initiative, Health Services Research & Development Service ; prepared by Evidence-based Synthesis Program (ESP) West Los Angeles VA Medical Center ; principal investigator, Paul G. Shekelle ; co-investigators, Melinda Maggard Gibbons, Jesus G. Ulloa, Ian T. Macqueen, Christopher P. Childers ; research associates, Isomi M. Miake-Lye, Roberta Shanman, Jessica M. Beroes
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|a Washington, DC
|b Department of Veterans Affairs, Health Services Research & Development Service
|c 2017, June 2017
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|a 1 PDF file (iii, 46 pages)
|b illustrations
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|a Includes bibliographical references
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|a Comparative Effectiveness Research
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|a Platelet Aggregation Inhibitors / adverse effects
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| 653 |
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|a Platelet Aggregation Inhibitors / therapeutic use
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| 653 |
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|a Cerebrovascular Disorders / drug therapy
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| 653 |
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|a Treatment Outcome
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| 653 |
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|a Risk Assessment
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| 653 |
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|a Coronary Disease / drug therapy
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|a United States
|b Department of Veterans Affairs
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|a Quality Enhancement Research Initiative (U.S.)
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|a West Los Angeles VA Medical Center
|b Evidence-Based Synthesis Program Center
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|a eng
|2 ISO 639-2
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|b NCBI
|a National Center for Biotechnology Information
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|a Evidence-based synthesis program
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|u https://www.ncbi.nlm.nih.gov/books/NBK470709
|3 Volltext
|n NLM Bookshelf Books
|3 Volltext
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|a 610
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|a 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
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