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. 2022 Oct 21;6(6):564-573.
doi: 10.1016/j.mayocpiqo.2022.09.006. eCollection 2022 Dec.

Perioperative Management of Antiplatelet Therapy: A Systematic Review and Meta-analysis

Sahrish Shah  1   2 , Meritxell Urtecho  1   2 , Mohammed Firwana  1   2 , Tarek Nayfeh  1   2 , Bashar Hasan  1   2 , Ahmad Nanaa  1   2 , Samer Saadi  1   2 , David N Flynn  3 , Rami Abd-Rabu  1   2 , Mohamed O Seisa  1   2 , Noora S Rajjoub  1   2 , Leslie C Hassett  4 , Alex C Spyropoulos  5 , James D Douketis  6 , M Hassan Murad  1   2
Affiliations

Perioperative Management of Antiplatelet Therapy: A Systematic Review and Meta-analysis

Sahrish Shah et al. Mayo Clin Proc Innov Qual Outcomes. .

Abstract

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.

Keywords: ACCP/CHEST, American College of Chest Physicians; ASA, acetylsalicylic acid; ATE, arterial thromboembolism; CABG, coronary artery bypass graft; COE, certainty of evidence; CV, cardiovascular; DES, drug-eluting stent; LMWH, low-molecular-weight heparin; MI, myocardial infarction; PE, pulmonary embolism; PICO, patients–interventions–comparators–outcomes; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RCT, randomized clinical trial; RR, relative risk.

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Figures

Figure
Figure
Selection of Studies for Inclusion in the Systematic Review and Meta-analysis.
See this image and copyright information in PMC

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