Perioperative management of antiplatelet agents

Aspirin therapy should no longer be withdrawn prior to most surgical procedures. However, with new antiplatelet agents such as prasugrel and ticagrelor, we will need to modify our daily clinical practice. These agents are likely to increase the perioperative bleeding risk. Depending on the potency of these new agents, treatment should be interrupted for >= 7 days for prasugrel, and for 5-7 days for ticagrelor (depending on the local summary of product characteristics) and clopidogrel before surgery or any invasive procedure; however, interrupting these treatments obviously increases thrombotic risk. Conversely, no antidote is available if haemorrhage occurs in a patient treated with clopidogrel, prasugrel or ticagrelor. Platelet transfusion can help to control bleeding, probably more easily in clopidogrel-treated or prasugrel-treated patients than in those treated with ticagrelor, but could potentially increase thrombotic risk. For the postoperative resumption of treatment, no loading dose should be given. (C) 2012 Elsevier Masson SAS. All rights reserved.