Gestion périopératoire des antiplaquettaires.

Aspirin, clopidogrel, prasugrel and ticagrelor are major antiplatelet agents (AAP) currently prescribed. Aspirin increases the surgical bleeding risk; the question is whether this risk is acceptable for a programmed procedure in comparison with the cardiovascular risk associated with discontinuation of treatment. In patients with coronary stents, maintaining aspirin during surgery is the rule. In patients treated with clopidogrel, prasugrel or ticagrelor, due to an unacceptable bleeding risk-on, stopping the treatment for five, seven and five days, respectively, is enough to regain sufficient platelet function allowing an invasive procedure. The risk of cardiovascular events is “very high” within six weeks following the establishment of a simple or an active (drug-eluting) stent and “high” six months to one year after the implantation of an active stent. The drug-eluting second-generation stents are associated with a lower risk of thrombosis than the first-generation, close to that of bare stents. This would reduce the risk period from six to three months after the coronary stenting. The post-surgery bleeding risk for patients receiving AAP is worsened by anticoagulants. There is currently no reliable biological marker for monitoring the haemorrhagic risk during the pre- and post-surgery periods, allowing a decision of interruption or reintroduction of AAP. To reduce the impact of AAP on the surgical bleeding risk, preventive or curative pharmacological strategies (tranexamic acid, desmopressin) or transfusion can be proposed. [ABSTRACT FROM AUTHOR]