Period of withdrawal of anti platelet agents prior to surgery

Period of withdrawal of anti platelet agents prior to surgery All patients with coronary stents will be on Aspirin and an additional agent which is a P2Y12 inhibitor (Clopidogrel, Prasugrel or Ticagrelor). The antiplatelet therapy is likely to be more aggressive in those on drug eluting stents (DES). More so in those who have been implanted with a DES in the past one year, because the risk of stent thrombosis on withdrawal on antiplatelet agents is higher in that period. Platelet function recovery takes place at the rate of about 10% per day. But full recovery of function may not be required for adequate hemostasis with platelet aggregation. There is also a chance of rebound prothrombotic state with higher levels of thromboxane A2. Hence perioperative withdrawal of aspirin carries a significant risk of ischemia. There is significant evidence to suggest that aspirin should not be withdrawn prior to most non cardiac surgeries unless the bleeding risk of the surgery is high as in case of neurosurgery and trans urethral resection of prostate (TURP). Clopidogrel is withdrawn 5 days prior to surgery while Prasugrel needs to be withdrawn 7 days prior to surgery. Prasugrel is a third generation thienopyridine with faster onset of action and more irreversible platelet inhibition than clopidogrel. Ticagrelor also has a more rapid onset of action and more consistent anti platelet action than clopidogrel. Being an anti platelet agent with reversible action, the offset of action is more...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: General Cardiology Clopidogrel P2Y12 inhibitor Prasugrel rebound prothrombotic state Thromboxane A2 ticagrelor trans urethral resection of prostate TURP and anti platelet therapy withdrawal of anti-platelet agents prior to surgery Source Type: blogs