Lisbon, Portugal - A session on the best practice for operating on patients taking antiplatelet therapies was well received at the European Association for Cardio-Thoracic Surgery (EACTS) 2011 Annual Meeting this week, with attendees saying they welcomed advice on this topic in light of the newer antiplatelet agents coming onto the market.
Surgeons generally want to stop antiplatelet therapy several days before an operation to reduce bleeding risk, but this can have a negative impact in terms of thrombotic events, particularly if a patient has recently had a drug-eluting stent (DES) placed. And while there are recommendations for when to stop antiplatelet therapy prior to surgery—generally advised at five days beforehand for clopidogrel, three days for ticagrelor, and seven days for prasugrel—"the reality is that very often we have to proceed with surgery much faster," surgeon Dr A Pieter Kappetein (Erasmus Medical Center, Rotterdam, the Netherlands) told the meeting.
Cardiologist Dr Freek Verheugt (Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands) acknowledged that "the eternal difficulty for the surgeon is balancing the risks of bleeding and thrombosis," in a sentiment that was echoed in another talk on "tips and tricks for operating under antiplatelet therapy," given by Dr Miguel Sousa Uva (Hospital da Cruz Vermelha Portuguesa, Lisbon).
Both Verheught and Sousa Uva stressed that the key to determining what to do about dual antiplatelet therapy in the face of surgery is to use individual risk assessment, on a case-by-case basis, and they advised using an algorithm to aid in this decision, taken from the latest European guidelines on revascularization.
Following the session, cochair Dr Jose Luis Pomar (Hospital Clinico de Barcelona, Spain) observed: "This is a very interesting topic. After this, I believe we are still ignorant, but perhaps we have a bit more understanding than before."