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Perioperative Management of Antiplatelet Therapy: A Systematic Review and Meta-analysis

OBJECTIVE: To summarize the available evidence about the perioperative management of patients who are receiving long-term antiplatelet therapy and require elective surgery/procedures. METHODS: This systematic review supports the development of the American College of Chest Physicians guideline on th...

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Detalles Bibliográficos
Autores principales: Shah, Sahrish, Urtecho, Meritxell, Firwana, Mohammed, Nayfeh, Tarek, Hasan, Bashar, Nanaa, Ahmad, Saadi, Samer, Flynn, David N., Abd-Rabu, Rami, Seisa, Mohamed O., Rajjoub, Noora S., Hassett, Leslie C., Spyropoulos, Alex C., Douketis, James D., Murad, M. Hassan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9594114/
https://www.ncbi.nlm.nih.gov/pubmed/36304523
http://dx.doi.org/10.1016/j.mayocpiqo.2022.09.006
Descripción
Sumario:OBJECTIVE: To summarize the available evidence about the perioperative management of patients who are receiving long-term antiplatelet therapy and require elective surgery/procedures. METHODS: This systematic review supports the development of the American College of Chest Physicians guideline on the perioperative management of antiplatelet therapy. A literature search of MEDLINE, EMBASE, Scopus and Cochrane databases was conducted from each database’s inception to July 16, 2020. Meta-analyses were conducted when possible. RESULTS: In patients receiving long-term antiplatelet therapy and undergoing elective noncardiac surgery, the available evidence did not show a significant difference in major bleeding between a shorter vs longer antiplatelet interruption, with low certainty of evidence (COE). Compared with patients who received placebo perioperatively, aspirin continuation was associated with increased risk of major bleeding (relative risk [RR], 1.31; 95% CI, 1.15-1.50; high COE) and lower risk of major thromboembolism (RR, 0.74; 95% CI, 0.58-0.94; moderate COE). During antiplatelet interruption, bridging with low-molecular-weight heparin was associated with increased risk of major bleeding compared with no bridging (RR, 1.86; 95% CI, 1.24-2.79; very low COE). Continuation of antiplatelets during minor dental and ophthalmologic procedures was not associated with a statistically significant difference in the risk of major bleeding (very low COE). CONCLUSION: This systematic review summarizes the current evidence about the perioperative management of antiplatelet therapy and highlights the urgent need for further research, particularly with the increasing prevalence of patients taking 1 or more antiplatelet agents.