Antiplatelet therapy in the perioperative period.

antiplatelet drugs are the cornerstone
treatment in the secondary prevention of arterial
thrombosis. Until recently, their intake was interrupted
in the perioperative period because of fear
for bleeding, but new insights have challenged this
old habit. in patients at high risk for atherothrombotic
events who need to undergo surgery or an
invasive procedure, the risk for bleeding complications
because of a treatment with low-dose acetylsalicylic
acid (lD aSa) needs to be balanced
against the risk of atherothrombotic events after
treatment discontinuation. for patients at high risk
of atherothrombotic complications recent guidelines
do no longer advocate to interrupt lD aSa
routinely. However, the likelihood of bleeding versus
atherothrombotic complications should be considered
on a case-by-case basis. when continued
perioperatively, the bleeding risk associated with
thienopyridines (ticlopidine, clopidogrel and prasugrel)
is higher than that of lD aSa. it is recommended
to stop their intake 1 week before the surgical
intervention, except in patients with (recent) coronary stenting