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ESP Report: Management of Antiplatelet Therapy among Patients on Antiplatelet Therapy for Coronary or Cerebrovascular Disease

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Management of Antiplatelet Therapy among Patients on Antiplatelet Therapy for Coronary or Cerebrovascular Disease

Principal Investigator: Paul Shekelle, MD, PhD
Co-Investigators: CP Childers, MD; Melinda Maggard Gibbons, MD, MSHS; Jesus G. Ulloa, MD, MBA; Ian T. Macqueen, MD
Research Associates: Isomi M. Miake-Lye, PhDc; Roberta Shanman, MLS; Jessica M. Beroes, BS



Evidence-based Synthesis Program (ESP) Center, West Los Angeles VA Medical Center, Los Angeles, CA

Washington (DC): Department of Veterans Affairs; June 2017.

Download PDF: Complete Report, Abstract, Report, Appendices



Introduction

The perioperative management of antiplatelet therapy for patients with coronary stents remains unclear. This review was requested to assess the evidence for the following key questions:

1.Among patients on APT in conjunction with percutaneous coronary intervention (PCI)undergoing elective surgical procedures, including intraocular procedures, what are the benefits and harms of holding APT prior to surgery?

2.How does benefit/risk vary by the timing of discontinuation?

3.How does benefit/risk vary by type of surgical procedure, including intraocular procedures?

4.How does benefit/risk vary by type of APT?

5.How does benefit/risk vary by the timing of resuming APT?


See also

Management of Antiplatelet Therapy among Patients with Coronary or Cerebrovascular Disease (Management Brief)

Childers CP, Maggard-Gibbons M, Shekelle PG. Antiplatelet Therapy in Patients with Coronary Stents Undergoing Elective Noncardiac Surgery: Continue, Stop, or Something in Between? Journal of the American Medical Association. Published online June 19, 2017. doi:10.1001/jama.2017.7845

Childers C, Maggard-Gibbons M, Ulloa J, et al. Perioperative management of antiplatelet therapy in patients undergoing non-cardiac surgery following coronary stent placement: a systematic review. Systematic Reviews. 2018;7:4. https://doi.org/10.1186/s13643-017-0635-z