How to undertake procedures while on antiplatelet agents: a hematologist's view

• Published in: Research and practice in thrombosis and haemostasis 2024-08, Vol.8 (6), p.102539, Article 102539
• Main Authors: Swan, Dawn, Turner, Robert, Douketis, James, Thachil, Jecko
• Format: Article
• Language: English
• Subjects: anesthesia; antiplatelet; aspirin; bleeding; clopidogrel; prasugrel; Review; surgery; ticagrelor
• ISSN: 2475-0379; 2475-0379
• DOI: 10.1016/j.rpth.2024.102539

Cardiovascular diseases (CVDs) are the leading cause of mortality globally while also contributing to excess health system costs. Significant advancements have been made in the understanding and prevention of deaths from CVD. In addition to risk factor modifications, one of the key developments in this area is the appropriate prescribing of antiplatelet medications for secondary prevention of CVD. With the advent of vascular devices, there has been an increased use of potent antiplatelet agents to mitigate thrombosis risk. A well-recognized, albeit rare complication of antiplatelet drugs is the heightened risk of bleeding. This adverse effect is particularly relevant when a patient receiving these medications may require an urgent surgery. In addition, for elective surgeries, although these drugs can be withheld, there may be some situations when interruption of antiplatelet agents, even for short duration, may lead to thrombotic events. There are no robust guidelines on how to manage these clinical scenarios, although there have been some important studies published recently in this area. In this review, we provide our approach to patients on antiplatelet drugs who may require urgent surgeries or surgical interventions. [Display omitted] •Several guidelines provide recommendations concerning interruption of antiplatelet therapy for elective procedures or interventions.•This articles aims to provide an update on these recommendations as well as including pragmatic approaches for urgent cases.•Bridging therapy therapy may be required for select situations where there is high thrombotic risk. The evidence base underpinning this is not rigorous, and requires case-by-case multidisciplinary discussion.•Aiming to minimise interruption of antiplatelet therapy is recommended for the majority of lower thrombotic risk cases.