Perioperative Management of Antiplatelet Therapy: A Systematic Review and Meta-analysis.
ACCP/CHEST, American College of Chest Physicians
ASA, acetylsalicylic acid
ATE, arterial thromboembolism
CABG, coronary artery bypass graft
COE, certainty of evidence
CV, cardiovascular
DES, drug-eluting stent
LMWH, low-molecular-weight heparin
MI, myocardial infarction
PE, pulmonary embolism
PICO, patients–interventions–comparators–outcomes
PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
RCT, randomized clinical trial
RR, relative risk
Journal
Mayo Clinic proceedings. Innovations, quality & outcomes
ISSN: 2542-4548
Titre abrégé: Mayo Clin Proc Innov Qual Outcomes
Pays: Netherlands
ID NLM: 101728275
Informations de publication
Date de publication:
Dec 2022
Dec 2022
Historique:
entrez:
28
10
2022
pubmed:
29
10
2022
medline:
29
10
2022
Statut:
epublish
Résumé
To summarize the available evidence about the perioperative management of patients who are receiving long-term antiplatelet therapy and require elective surgery/procedures. 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. 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). 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.
Identifiants
pubmed: 36304523
doi: 10.1016/j.mayocpiqo.2022.09.006
pii: S2542-4548(22)00067-4
pmc: PMC9594114
doi:
Types de publication
Journal Article
Langues
eng
Pagination
564-573Informations de copyright
© 2022 The Authors.
Références
Ann Card Anaesth. 2015 Jan-Mar;18(1):45-51
pubmed: 25566711
PLoS Med. 2009 Jul 21;6(7):e1000097
pubmed: 19621072
World Neurosurg. 2015 Jul;84(1):41-7
pubmed: 25727304
Acta Ophthalmol Scand. 2003 Feb;81(1):38-40
pubmed: 12631017
J Thorac Cardiovasc Surg. 2012 Jul;144(1):204-9
pubmed: 22554721
Catheter Cardiovasc Interv. 2011 Jun 1;77(7):972-6
pubmed: 20824750
PLoS One. 2015 Jul 31;10(7):e0134670
pubmed: 26230605
J Thromb Haemost. 2015 Nov;13(11):2119-26
pubmed: 26764429
Circulation. 2005 Aug 30;112(9 Suppl):I286-92
pubmed: 16159833
J Thorac Cardiovasc Surg. 2014 Dec;148(6):3092-8
pubmed: 24954178
Eur J Vasc Endovasc Surg. 2005 Feb;29(2):156-61
pubmed: 15649722
J Neurosurg. 2019 Apr 05;132(5):1529-1538
pubmed: 30952120
N Engl J Med. 2016 Feb 25;374(8):728-37
pubmed: 26933848
Ophthalmology. 2003 Sep;110(9):1784-8
pubmed: 13129878
Lancet. 2000 Apr 15;355(9212):1295-302
pubmed: 10776741
Circulation. 2004 Sep 7;110(10):1202-8
pubmed: 15313956
Br J Anaesth. 2010 Mar;104(3):305-12
pubmed: 20150346
Ophthalmic Plast Reconstr Surg. 2020 Nov/Dec;36(6):575-578
pubmed: 32251176
Eur J Cardiothorac Surg. 2015 Oct;48(4):e64-70
pubmed: 26248820
Thorac Cardiovasc Surg. 2013 Dec;61(8):726-30
pubmed: 23344762
Circulation. 2006 Jun 20;113(24):2803-9
pubmed: 16769908
Neth Heart J. 2017 Sep;25(9):482-489
pubmed: 28612281
J Korean Surg Soc. 2013 Oct;85(4):185-90
pubmed: 24106686
Langenbecks Arch Surg. 2012 Feb;397(2):297-306
pubmed: 22048442
Thorac Cardiovasc Surg. 2018 Sep;66(6):442-451
pubmed: 29172212
Chest. 2012 Feb;141(2 Suppl):e326S-e350S
pubmed: 22315266
Catheter Cardiovasc Interv. 2004 Oct;63(2):141-5
pubmed: 15390248
Thromb Haemost. 2015 Aug;114(2):423-31
pubmed: 26017898
J Maxillofac Oral Surg. 2017 Mar;16(1):48-52
pubmed: 28286384
PLoS One. 2015 Feb 23;10(2):e0116311
pubmed: 25706957
Chest. 2022 Aug 11;:
pubmed: 35964704
J Clin Epidemiol. 2011 Dec;64(12):1283-93
pubmed: 21839614
J Am Coll Cardiol. 2002 Jul 17;40(2):231-7
pubmed: 12106925
J Clin Pharm Ther. 2022 May;47(5):652-661
pubmed: 34939677
Ann Thorac Surg. 2015 Jun;99(6):1975-81
pubmed: 25912742
JAMA. 2013 Oct 9;310(14):1462-72
pubmed: 24101118
Surg Endosc. 2016 Dec;30(12):5542-5549
pubmed: 27129549
Chest. 2022 Aug 11;:
pubmed: 35964703
Eur J Cardiothorac Surg. 2019 Apr 1;55(4):714-720
pubmed: 30358828
Ann Surg. 2015 Dec;262(6):1150-6
pubmed: 25361218
Am J Surg. 2016 Jun;211(6):1019-25
pubmed: 27002953
J Cardiothorac Vasc Anesth. 2012 Apr;26(2):245-50
pubmed: 22138313
PLoS One. 2017 Jul 17;12(7):e0180466
pubmed: 28715503
J Dent Res. 2008 Aug;87(8):740-4
pubmed: 18650545
Daru. 2016 Jul 28;24(1):20
pubmed: 27465859
Ann Thorac Surg. 2015 Feb;99(2):576-80
pubmed: 25499478
J Am Dent Assoc. 2000 Mar;131(3):331-5
pubmed: 10715924
Br J Anaesth. 2011 Dec;107(6):899-910
pubmed: 21873632
J Plast Reconstr Aesthet Surg. 2018 Apr;71(4):455-467
pubmed: 29233507
N Engl J Med. 2014 Apr 17;370(16):1494-503
pubmed: 24679062
J Clin Epidemiol. 2021 Sep;137:163-175
pubmed: 33857619
JAMA Surg. 2013 Jun;148(6):538-47
pubmed: 23426385