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Antiplatelet therapy in ENT surgery: a review

Published online by Cambridge University Press:  19 December 2011

D C Sylvester  and
A P Coatesworth
D C Sylvester*
Affiliation:
Department of Otolaryngology, York Hospital, UK
A P Coatesworth
Affiliation:
Department of Otolaryngology, York Hospital, UK
*
Address for correspondence: Miss D C Sylvester, Department of Otolaryngology, York Hospital, York YO31 8HE, UK Fax: +44 (0)1904 726346 E-mail: dsylvester@doctors.net.uk
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Abstract

Introduction:

Antiplatelet agents such as aspirin and clopidogrel are increasingly encountered in clinical practice. Otorhinolaryngological surgeons are involved in the peri-operative decision of whether to continue treatment and risk haemorrhage or to discontinue treatment and risk thrombosis.

Methods:

Literature relating to the risk of spontaneous or operative haemorrhage was reviewed. The morbidity and mortality associated with cessation of agents was evaluated. Published guidelines were also evaluated. A protocol for the management of antiplatelet agents in the peri-operative period, with particular reference to ENT operations, is presented.

Conclusion:

Significant morbidity and mortality is associated with the premature cessation of antiplatelet agents. Data from cardiac surgery suggest that operative blood loss only marginally increases in patients on aspirin and clopidogrel. However, the management of antiplatelet agents in the peri-operative period should be made after multidisciplinary consultation.

Keywords

Anti-platelet AgentsAspirinClopidogrelHaemorrhagePerioperative PeriodThrombosis
Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 126 , Issue 4 , April 2012 , pp. 331 - 336
Copyright
Copyright © JLO (1984) Limited 2011

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References

1Living with heart disease. In: http://www.bhf.org.uk/heart-health/statistics/morbidity/living-with-heart-disease.aspx [23 September 2011]Google Scholar
2Eagle, KA, Berger, PB, Calkins, H, Chaitman, BR, Ewy, GA, Fleischmann, KE et al. ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery—executive summary a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Circulation 2002;105:1257–67Google Scholar
3Newsome, LT, Weller, RS, Gerancher, JC, Kutcher, MA, Royster, RL. Coronary artery stents: II. Perioperative considerations and management. Anesth Analg 2008;107:570–90CrossRefGoogle ScholarPubMed
4Smith, SC Jr, Feldman, TE, Hirshfeld, JW Jr, Jacobs, AK, Kern, MJ, King, SB 3rd et al. ACC/AHA/SCAI 2005 Guideline update for percutaneous coronary intervention-summary article: A report of the American College of Cardiology/American Heart Association task force on practice guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention). J Am Coll Cardiol 2006;47:216–35CrossRefGoogle Scholar
5Peters, RJ, Mehta, SR, Fox, KA, Zhao, F, Lewis, BS, Kopecky, SL et al. Effects of aspirin dose when used alone or in combination with clopidogrel in patients with acute coronary syndromes: observations from the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) study. Circulation 2003;108:1682–7CrossRefGoogle ScholarPubMed
6Harder, S, Klinkhardt, U, Alvarez, JM. Avoidance of bleeding during surgery in patients receiving anticoagulant and/or antiplatelet therapy: pharmacokinetic and pharmacodynamic considerations. Clin Pharmacokinet 2004;43:963–81CrossRefGoogle ScholarPubMed
7Antithrombotic Trialists' Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002;324:71–86CrossRefGoogle Scholar
8Harrington, RA, Becker, RC, Ezekowitz, M, Meade, TW, O'Connor, CM, Vorchheimer, DA et al. Antithrombotic therapy for coronary artery disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126 (suppl 3):513–48SCrossRefGoogle ScholarPubMed
9Rodondi, N, Cornuz, J. The role of aspirin in the primary prevention of cardiovascular disease [in French]. Rev Med Suisse 2006;2:646–51Google ScholarPubMed
10Yusuf, S, Zhao, F, Mehta, SR, Chrolavicius, S, Tognoni, G, Fox, KK. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 2001;345:494–502Google ScholarPubMed
11National Institute for Health and Clinical Excellence. CG94 Unstable Angina and NSTEMI. London: NICE, 2010Google Scholar
12National Institute for Health and Clinical Excellence. CG48 MI: Secondary Prevention: Consultation Document. London: NICE, 2007Google Scholar
13Mehta, SR, Yusuf, S, Peters, RJ, Bertrand, ME, Lewis, BS, Natarajan, MK et al. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet 2001;358:527–33CrossRefGoogle ScholarPubMed
14Steinhubl, SR, Berger, PB, Mann, JT 3rd, Fry, ET, DeLago, A, Wilmer, C et al. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. JAMA 2002;288:2411–20CrossRefGoogle ScholarPubMed
15Wiviott, SD, Braunwald, E, McCabe, CH, Montalescot, G, Ruzyllo, W, Gottlieb, S et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2007;357:2001–15CrossRefGoogle ScholarPubMed
16National Institute for Health and Clinical Excellence. Clopidogrel and Modified-Released dipyridamole for the Prevention of Occlusive Vascular Events. London: NICE, 2010Google Scholar
17Montalescot, G, Barragan, P, Wittenberg, O, Ecollan, P, Elhadad, S, Villain, P et al. Platelet glycoprotein IIb/IIIa inhibition with coronary stenting for acute myocardial infarction. N Engl J Med 2001;344:1895–903CrossRefGoogle ScholarPubMed
18Tcheng, JE, Ellis, SG, George, BS, Kereiakes, DJ, Kleiman, NS, Talley, JD et al. Pharmacodynamics of chimeric glycoprotein IIb/IIIa integrin antiplatelet antibody Fab 7E3 in high-risk coronary angioplasty. Circulation 1994;90:1757–64CrossRefGoogle ScholarPubMed
19Eikelboom, J, Hirsh, J. Bleeding and management of bleeding. Eur Heart J Suppl 2006;8(suppl G):G38–45CrossRefGoogle Scholar
20Serebruany, VL, Malinin, AI, Eisert, RM, Sane, DC. Risk of bleeding complications with antiplatelet agents: meta-analysis of 338,191 patients enrolled in 50 randomized controlled trials. Am J Hematol 2004;75:40–7CrossRefGoogle ScholarPubMed
21Burger, W, Chemnitius, JM, Kneissl, GD, Rucker, G. Low-dose aspirin for secondary cardiovascular prevention – cardiovascular risks after its perioperative withdrawal versus bleeding risks with its continuation – review and meta-analysis. J Intern Med 2005;257:399–414CrossRefGoogle ScholarPubMed
22Belisle, S, Hardy, JF. Hemorrhage and the use of blood products after adult cardiac operations: myths and realities. Ann Thorac Surg 1996;62:1908–17CrossRefGoogle Scholar
23Thurston, AV, Briant, SL. Aspirin and post-prostatectomy haemorrhage. Br J Urol 1993;71:574–6CrossRefGoogle ScholarPubMed
24Kapetanakis, EI, Medlam, DA, Boyce, SW, Haile, E, Hill, PC, Dullum, MK et al. Clopidogrel administration prior to coronary artery bypass grafting surgery: the cardiologist's panacea or the surgeon's headache? Eur Heart J 2005;26:576–83CrossRefGoogle ScholarPubMed
25Chu, MW, Wilson, SR, Novick, RJ, Stitt, LW, Quantz, MA. Does clopidogrel increase blood loss following coronary artery bypass surgery? Ann Thorac Surg 2004;78:1536–41CrossRefGoogle ScholarPubMed
26Wilson, SH, Fasseas, P, Orford, JL, Lennon, RJ, Horlocker, T, Charnoff, NE et al. Clinical outcome of patients undergoing non-cardiac surgery in the two months following coronary stenting. J Am Coll Cardiol 2003;42:234–40CrossRefGoogle ScholarPubMed
27Ernst, A, Eberhardt, R, Wahidi, M, Becker, HD, Herth, FJ. Effect of routine clopidogrel use on bleeding complications after transbronchial biopsy in humans. Chest 2006;129:734–7CrossRefGoogle ScholarPubMed
28Sargi, Z, Casiano, R. Endoscopic sinus surgery in patients receiving anticoagulant or antiplatelet therapy. Am J Rhinol 2007;21:335–8CrossRefGoogle ScholarPubMed
29Stage, J, Jensen, JH, Bonding, P. Post-tonsillectomy haemorrhage and analgesics. A comparative study of acetylsalicylic acid and paracetamol. Clin Otolaryngol Allied Sci. 1988;13(3):201–4CrossRefGoogle ScholarPubMed
30Collet, JP, Montalescot, G, Blanchet, B, Tanguy, ML, Golmard, JL, Choussat, R et al. Impact of prior use or recent withdrawal of oral antiplatelet agents on acute coronary syndromes. Circulation 2004;110:2361–7CrossRefGoogle ScholarPubMed
31Iakovou, I, Schmidt, T, Bonizzoni, E, Ge, L, Sangiorgi, GM, Stankovic, G et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA 2005;293:2126–30CrossRefGoogle ScholarPubMed
32Ferrari, E, Benhamou, M, Cerboni, P, Marcel, B. Coronary syndromes following aspirin withdrawal: a special risk for late stent thrombosis. J Am Coll Cardiol 2005;45:456–9CrossRefGoogle ScholarPubMed
33Sharma, AK, Ajani, AE, Hamwi, SM, Maniar, P, Lakhani, SV, Waksman, R et al. Major noncardiac surgery following coronary stenting: when is it safe to operate? Catheter Cardiovasc Interv 2004;63:141–5CrossRefGoogle ScholarPubMed
34Jeremias, A, Sylvia, B, Bridges, J, Kirtane, AJ, Bigelow, B, Pinto, DS et al. Stent thrombosis after successful sirolimus-eluting stent implantation. Circulation 2004;109:1930–2CrossRefGoogle ScholarPubMed
35McFadden, EP, Stabile, E, Regar, E, Cheneau, E, Ong, AT, Kinnaird, T et al. Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy. Lancet 2004;364:1519–21CrossRefGoogle ScholarPubMed
36Ong, AT, Hoye, A, Aoki, J, van Mieghem, CA, Rodriguez Granillo, GA, Sonnenschein, K et al. Thirty-day incidence and six-month clinical outcome of thrombotic stent occlusion after bare-metal, sirolimus, or paclitaxel stent implantation. J Am Coll Cardiol 2005;45:947–53CrossRefGoogle ScholarPubMed
37Kuchulakanti, PK, Chu, WW, Torguson, R, Ohlmann, P, Rha, SW, Clavijo, LC et al. Correlates and long-term outcomes of angiographically proven stent thrombosis with sirolimus- and paclitaxel-eluting stents. Circulation 2006;113:1108–13CrossRefGoogle ScholarPubMed
38Park, DW, Park, SW, Park, KH, Lee, BK, Kim, YH, Lee, CW et al. Frequency of and risk factors for stent thrombosis after drug-eluting stent implantation during long-term follow-up. Am J Cardiol 2006;98:352–6CrossRefGoogle ScholarPubMed
39Urban, P, Gershlick, AH, Guagliumi, G, Guyon, P, Lotan, C, Schofer, J et al. Safety of coronary sirolimus-eluting stents in daily clinical practice: one-year follow-up of the e-Cypher registry. Circulation 2006;113:1434–41CrossRefGoogle ScholarPubMed
40Harty, JA, McKenna, P, Moloney, D, D'Souza, L, Masterson, E. Anti-platelet agents and surgical delay in elderly patients with hip fractures. J Orthop Surg (Hong Kong) 2007;15:270–2CrossRefGoogle ScholarPubMed
41Lecompte, T, Hardy, JF. Antiplatelet agents and perioperative bleeding. Can J Anaesth 2006;53(suppl 6):S103–12CrossRefGoogle ScholarPubMed
42Chassot, PG, Delabays, A, Spahn, DR. Perioperative antiplatelet therapy: the case for continuing therapy in patients at risk of myocardial infarction. Br J Anaesth 2007;99:316–28CrossRefGoogle ScholarPubMed
43Douketis, JD, Berger, PB, Dunn, AS, Jaffer, AK, Spyropoulos, AC, Becker, RC et al. The perioperative management of antithrombotic therapy: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest 2008;133(suppl 6):299–339SCrossRefGoogle ScholarPubMed
44Llau, JV, Lopez-Forte, C, Sapena, L, Ferrandis, R. Perioperative management of antiplatelet agents in noncardiac surgery. Eur J Anaesthesiol 2009;26:181–7CrossRefGoogle ScholarPubMed
45Servin, F. Low-dose aspirin and clopidogrel: how to act in patients scheduled for day surgery. Curr Opin Anaesthesiol 2007;20:531–4CrossRefGoogle ScholarPubMed
46Broad, L, Lee, T, Conroy, M, Bolsin, S, Orford, N, Black, A et al. Successful management of patients with a drug-eluting coronary stent presenting for elective, non-cardiac surgery. Br J Anaesth 2007;98:19–22CrossRefGoogle ScholarPubMed