Perioperative Management of Antiplatelet Therapy: A Systematic Review and Meta-analysis
Objective: To summarize the available evidence about the perioperative management of patients who are receiving long-term antiplatelet therapy and require elective surgery/procedures. Methods: This systematic review supports the development of the American College of Chest Physicians guideline on th...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-12-01
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| Series: | Mayo Clinic Proceedings: Innovations, Quality & Outcomes |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2542454822000674 |
| _version_ | 1828173793954103296 |
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| author | Sahrish Shah, MBBS Meritxell Urtecho, MD Mohammed Firwana, MBBS Tarek Nayfeh, MD Bashar Hasan, MD Ahmad Nanaa, MD Samer Saadi, MD David N. Flynn, MD, MBA Rami Abd-Rabu, MBBS Mohamed O. Seisa, MD Noora S. Rajjoub Leslie C. Hassett, ML Alex C. Spyropoulos, MD, FACP, FCCP, FRCPC James D. Douketis, MD, FCCP M. Hassan Murad, MD, MPH |
| author_facet | Sahrish Shah, MBBS Meritxell Urtecho, MD Mohammed Firwana, MBBS Tarek Nayfeh, MD Bashar Hasan, MD Ahmad Nanaa, MD Samer Saadi, MD David N. Flynn, MD, MBA Rami Abd-Rabu, MBBS Mohamed O. Seisa, MD Noora S. Rajjoub Leslie C. Hassett, ML Alex C. Spyropoulos, MD, FACP, FCCP, FRCPC James D. Douketis, MD, FCCP M. Hassan Murad, MD, MPH |
| author_sort | Sahrish Shah, MBBS |
| collection | DOAJ |
| description | Objective: To summarize the available evidence about the perioperative management of patients who are receiving long-term antiplatelet therapy and require elective surgery/procedures. Methods: This systematic review supports the development of the American College of Chest Physicians guideline on the perioperative management of antiplatelet therapy. A literature search of MEDLINE, EMBASE, Scopus and Cochrane databases was conducted from each database’s inception to July 16, 2020. Meta-analyses were conducted when possible. Results: In patients receiving long-term antiplatelet therapy and undergoing elective noncardiac surgery, the available evidence did not show a significant difference in major bleeding between a shorter vs longer antiplatelet interruption, with low certainty of evidence (COE). Compared with patients who received placebo perioperatively, aspirin continuation was associated with increased risk of major bleeding (relative risk [RR], 1.31; 95% CI, 1.15-1.50; high COE) and lower risk of major thromboembolism (RR, 0.74; 95% CI, 0.58-0.94; moderate COE). During antiplatelet interruption, bridging with low-molecular-weight heparin was associated with increased risk of major bleeding compared with no bridging (RR, 1.86; 95% CI, 1.24-2.79; very low COE). Continuation of antiplatelets during minor dental and ophthalmologic procedures was not associated with a statistically significant difference in the risk of major bleeding (very low COE). Conclusion: This systematic review summarizes the current evidence about the perioperative management of antiplatelet therapy and highlights the urgent need for further research, particularly with the increasing prevalence of patients taking 1 or more antiplatelet agents. |
| first_indexed | 2024-04-12T04:02:22Z |
| format | Article |
| id | doaj.art-007c67d539574fa4a96dbc954e4ac21a |
| institution | Directory Open Access Journal |
| issn | 2542-4548 |
| language | English |
| last_indexed | 2024-04-12T04:02:22Z |
| publishDate | 2022-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Mayo Clinic Proceedings: Innovations, Quality & Outcomes |
| spelling | doaj.art-007c67d539574fa4a96dbc954e4ac21a2022-12-22T03:48:41ZengElsevierMayo Clinic Proceedings: Innovations, Quality & Outcomes2542-45482022-12-0166564573Perioperative Management of Antiplatelet Therapy: A Systematic Review and Meta-analysisSahrish Shah, MBBS0Meritxell Urtecho, MD1Mohammed Firwana, MBBS2Tarek Nayfeh, MD3Bashar Hasan, MD4Ahmad Nanaa, MD5Samer Saadi, MD6David N. Flynn, MD, MBA7Rami Abd-Rabu, MBBS8Mohamed O. Seisa, MD9Noora S. Rajjoub10Leslie C. Hassett, ML11Alex C. Spyropoulos, MD, FACP, FCCP, FRCPC12James D. Douketis, MD, FCCP13M. Hassan Murad, MD, MPH14Evidence-Based Practice Research Program, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MNEvidence-Based Practice Research Program, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MNEvidence-Based Practice Research Program, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MNEvidence-Based Practice Research Program, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MNEvidence-Based Practice Research Program, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MNEvidence-Based Practice Research Program, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MNEvidence-Based Practice Research Program, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MNUniversity of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NCEvidence-Based Practice Research Program, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MNEvidence-Based Practice Research Program, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MNEvidence-Based Practice Research Program, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MNMayo Clinic Libraries, Mayo Clinic, Rochester, MNInstitute of Health Systems Science - Feinstein Institutes for Medical Research and The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, and Department of Medicine, Anticoagulation and Clinical Thrombosis Services, Northwell Health at Lenox Hill Hospital, NY, NYDepartment of Medicine, McMaster University, Hamilton, CanadaEvidence-Based Practice Research Program, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Correspondence: Address to M. Hassan Murad MD, MPH, Mayo Clinic Evidence-Based Practice Center, 200 1st St SW, Rochester, MN 55905Objective: To summarize the available evidence about the perioperative management of patients who are receiving long-term antiplatelet therapy and require elective surgery/procedures. Methods: This systematic review supports the development of the American College of Chest Physicians guideline on the perioperative management of antiplatelet therapy. A literature search of MEDLINE, EMBASE, Scopus and Cochrane databases was conducted from each database’s inception to July 16, 2020. Meta-analyses were conducted when possible. Results: In patients receiving long-term antiplatelet therapy and undergoing elective noncardiac surgery, the available evidence did not show a significant difference in major bleeding between a shorter vs longer antiplatelet interruption, with low certainty of evidence (COE). Compared with patients who received placebo perioperatively, aspirin continuation was associated with increased risk of major bleeding (relative risk [RR], 1.31; 95% CI, 1.15-1.50; high COE) and lower risk of major thromboembolism (RR, 0.74; 95% CI, 0.58-0.94; moderate COE). During antiplatelet interruption, bridging with low-molecular-weight heparin was associated with increased risk of major bleeding compared with no bridging (RR, 1.86; 95% CI, 1.24-2.79; very low COE). Continuation of antiplatelets during minor dental and ophthalmologic procedures was not associated with a statistically significant difference in the risk of major bleeding (very low COE). Conclusion: This systematic review summarizes the current evidence about the perioperative management of antiplatelet therapy and highlights the urgent need for further research, particularly with the increasing prevalence of patients taking 1 or more antiplatelet agents.http://www.sciencedirect.com/science/article/pii/S2542454822000674 |
| spellingShingle | Sahrish Shah, MBBS Meritxell Urtecho, MD Mohammed Firwana, MBBS Tarek Nayfeh, MD Bashar Hasan, MD Ahmad Nanaa, MD Samer Saadi, MD David N. Flynn, MD, MBA Rami Abd-Rabu, MBBS Mohamed O. Seisa, MD Noora S. Rajjoub Leslie C. Hassett, ML Alex C. Spyropoulos, MD, FACP, FCCP, FRCPC James D. Douketis, MD, FCCP M. Hassan Murad, MD, MPH Perioperative Management of Antiplatelet Therapy: A Systematic Review and Meta-analysis Mayo Clinic Proceedings: Innovations, Quality & Outcomes |
| title | Perioperative Management of Antiplatelet Therapy: A Systematic Review and Meta-analysis |
| title_full | Perioperative Management of Antiplatelet Therapy: A Systematic Review and Meta-analysis |
| title_fullStr | Perioperative Management of Antiplatelet Therapy: A Systematic Review and Meta-analysis |
| title_full_unstemmed | Perioperative Management of Antiplatelet Therapy: A Systematic Review and Meta-analysis |
| title_short | Perioperative Management of Antiplatelet Therapy: A Systematic Review and Meta-analysis |
| title_sort | perioperative management of antiplatelet therapy a systematic review and meta analysis |
| url | http://www.sciencedirect.com/science/article/pii/S2542454822000674 |
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