Document Detail


Urological surgery and antiplatelet drugs after cardiac and cerebrovascular accidents.
MedLine Citation:
PMID:  20399452     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: The perioperative treatment of patients on dual antiplatelet therapy after myocardial infarction, cerebrovascular event or coronary stent implantation represents an increasingly frequent issue for urologists and anesthesiologists. We assess the current scientific evidence and propose strategies concerning treatment of these patients. MATERIALS AND METHODS: A MEDLINE and PubMed search was conducted for articles related to antiplatelet therapy after myocardial infarction, coronary stents and cerebrovascular events, as well as the use of aspirin and/or clopidogrel in the context of surgery. RESULTS: Early discontinuation of antiplatelet therapy for secondary prevention is associated with a high risk of coronary thrombosis, which is further increased by the hypercoagulable state induced by surgery. Aspirin has recently been recommended as a lifelong therapy. Clopidogrel is mandatory for 6 weeks after myocardial infarction and bare metal stents, and for 12 months after drug-eluting stents. Surgery must be postponed beyond these waiting periods or performed with patients receiving dual antiplatelet therapy because withdrawal therapy increases 5 to 10 times the risk of postoperative myocardial infarction, stent thrombosis or death. The shorter the waiting period between revascularization and surgery the greater the risk of adverse cardiac events. The risk of surgical hemorrhage is increased approximately 20% by aspirin and 50% by clopidogrel. CONCLUSIONS: The risk of coronary thrombosis when antiplatelet agents are withdrawn before surgery is generally higher than the risk of surgical hemorrhage when antiplatelet agents are maintained. However, this issue has not yet been sufficiently evaluated in urological patients and in many instances during urological surgery the risk of bleeding can be dangerous. A thorough dialogue among surgeon, cardiologist and anesthesiologist is essential to determine all risk factors and define the best possible strategy for each patient.
Authors:
Daniel Eberli; Pierre-Guy Chassot; Tullio Sulser; Charles Marc Samama; Jean Mantz; Alain Delabays; Donat R Spahn
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  The Journal of urology     Volume:  183     ISSN:  1527-3792     ISO Abbreviation:  J. Urol.     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-13     Completed Date:  2010-06-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376374     Medline TA:  J Urol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2128-36     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Affiliation:
Urology Clinic, University Hospital Z?rich, CH-8091 Z?rich, Switzerland. daniel.eberli@usz.ch
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / drug therapy*
Algorithms
Humans
Myocardial Infarction / drug therapy*
Platelet Aggregation Inhibitors / therapeutic use*
Postoperative Hemorrhage / etiology
Risk Factors
Stents*
Stroke / drug therapy*
Urologic Surgical Procedures*
Chemical
Reg. No./Substance:
0/Platelet Aggregation Inhibitors
Comments/Corrections
Comment In:
J Urol. 2010 Jun;183(6):2136   [PMID:  20399453 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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