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Antiplatelet agents in perioperative noncardiac surgeries: to maintain or to suspend?

Authors Borges JMDM, Oliveira de Carvalho F, Gomes IA, Borges Rosa M, Sousa ACS

Received 28 April 2018

Accepted for publication 16 July 2018

Published 5 October 2018 Volume 2018:14 Pages 1887—1895


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Professor Garry Walsh

Juliana Maria Dantas Mendonça Borges,1,2,* Fernanda Oliveira de Carvalho,1,* Isla Alcântara Gomes,3,* Mario Borges Rosa,4,* Antonio Carlos Sobral Sousa1,*

1Nucleus of Post-Graduation in Health Sciences, Federal University of Sergipe, São Cristóvão, Brazil; 2Nucleus of Pharmacy, Tiradentes University, Aracaju, Brazil; 3Nucleus of Post-Graduation in Pharmaceutical Sciences, Federal University of Sergipe, São Cristóvão, Brazil; 4Institute for Safe Practice in Drug Use, Belo Horizonte, Brazil

*These authors contributed equally to this work

Background: When prescribing antiplatelet agents, physicians face the challenge of protecting patients from thromboembolic events without inducing bleeding damage. However, especially in the perioperative period, the use of these medications requires a carefully balanced assessment of their risks and benefits.
Objective: To conduct a systematic review to check whether the antiplatelet agent is to be maintained or suspended in the perioperative period of noncardiac surgeries.
Search strategy: A comprehensive literature search using Science Direct, Scopus, MEDLINE-PubMed, and Web of Science was undertaken.
Selection criteria: Clinical trials of noncardiac surgeries with patients taking regular antiplatelet therapy, published between 2013 and 2018.
Results: A total of 1,302 studies were initially identified, with only four meeting the inclusion criteria. The selected studies were conducted in different countries such as, including India (2), Serbia (1), and the USA (1). The age group was similar in all studies, from 61 to 75 years. The most frequent surgery was related to tooth extraction and transurethral resection of bladder cancer. There was a group of patients who used single antiplatelet agents and groups who used single therapy and double therapy. Acetylsalicylic acid was the common drug in all studies.
Conclusion: It was concluded that the clinical trials were classified as good quality and that it was not necessary to suspend antiplatelet therapy prior to surgical procedures such as dental extraction and transurethral resection of bladder cancer. It should be noted that it is necessary to jointly evaluate the type of antiplatelet agent, the thrombotic risk of the patient, and the hemorrhagic risk of the surgical procedure.

Keywords: platelet aggregation inhibitors, antiplatelet agent, surgery, systematic review

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