Department of Anaesthesiology and Intensive Care Medicine, Carol Davila University of Medicine and Pharmacy.
Department of Cardiac Anaeshesia and Intensive Care II.
Curr Opin Anaesthesiol. 2020 Jun;33(3):454-462. doi: 10.1097/ACO.0000000000000875.
Perioperative management of antiplatelet agents (APAs) in the setting of noncardiac surgery is a controversial topic of balancing bleeding versus thrombotic risks.
Recent data do not support a clear association between continuation or discontinuation of APAs and rates of ischemic events, bleeding complications, and mortality up to 6 months after surgery. Clinical factors, such as indication and urgency of the operation, time since stent placement, invasiveness of the procedure, preoperative cardiac optimization, underlying functional status, as well as perioperative control of supply-demand mismatch and bleeding may be more responsible for adverse outcome than antiplatelet management.
Perioperative management of antiplatelet therapy (APT) should be individually tailored based on consensus among the anesthesiologist, cardiologist, surgeon, and patient to minimize both ischemic/thrombotic and bleeding risks. Where possible, surgery should be delayed for a minimum of 1 month but ideally for 3-6 months from the index cardiac event. If bleeding risk is acceptable, dual APT (DAPT) should be continued perioperatively; otherwise P2Y12 inhibitor therapy should be discontinued for the minimum amount of time possible and aspirin monotherapy continued. If bleeding risk is prohibitive, both aspirin and P2Y12 inhibitor therapy should be interrupted and bridging therapy may be considered in patients with high thrombotic risk.
非心脏手术围手术期抗血小板药物（APAs）的管理是一个权衡出血和血栓风险的争议话题。
最近的数据不支持继续或停用 APA 与缺血事件、出血并发症以及术后 6 个月内的死亡率之间存在明确关联。临床因素，如手术的适应证和紧急程度、支架置入时间、手术的侵袭性、术前心脏优化、基础功能状态，以及围手术期供需失衡和出血的控制，可能比抗血小板管理更能导致不良结果。
抗血小板治疗（APT）的围手术期管理应根据麻醉师、心脏病专家、外科医生和患者之间的共识进行个体化定制，以最大程度地降低缺血/血栓形成和出血风险。如有可能，手术应至少延迟 1 个月，但理想情况下应在心脏事件发生后 3-6 个月进行。如果出血风险可以接受，应在围手术期继续双重抗血小板治疗（DAPT）；否则，应尽可能缩短 P2Y12 抑制剂治疗时间并继续使用阿司匹林单药治疗。如果出血风险不可接受，则应中断阿司匹林和 P2Y12 抑制剂治疗，并考虑在高血栓形成风险的患者中进行桥接治疗。
