Review article: any antiplatelet drugs: a review of its Pharmacology and management during perioperative period

Any antiplatelet drugs: a review of its Pharmacology and management during perioperative period Skip to main page content home current query previous queries CME subscribe ONLINE using send to (A) and (A) activate my account search go advanced search? user name password characters in Antiplatelet drugs: A review of their Pharmacology and management in the perioperative Period of Richard Hall, MD, FRCPC, FCCP * and c. David Mazer, MD, FRCPC ? ?

From the *Departments of Anesthesia, Medicine, Surgery, and Pharmacology, Dalhousie University/Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia; ?Keenan Research Center/Li Ka Shing Knowledge Translation Institute, Saint Michael's Hospital, Toronto; and ?Departments of Anesthesia and Physiology, University of Toronto, Toronto, Ontario, Canada. Address correspondence and reprint requests to C. David Mazer, MD, FRCPC, Department of Anesthesia, St. Michael's Hospital, 30 Bond St., Toronto, ON M5B 1W8, Canada. Address e-mail to mazerd{at}smh.ca. Abstract In the normal course of the delivery of care, anesthesiologists encounter many patients who are receiving drugs that affect platelet function as a fundamental part of primary and secondary management of atherosclerotic thrombotic disease. There are several antiplatelet drugs available for use in clinical practice and several under investigation. Aspirin and clopidogrel (alone and in combination) have been the most studied and have the most favorable risk-benefit profiles of drugs currently available. Prasugrel was recently approved for patients with acute coronary syndrome undergoing percutaneous interventions. Other drugs such as dipyridamole and cilostazol have not been as extensively investigated. There are several newer investigational drugs such as cangrelor and ticagrelor, but whether they confer significant additional benefits remains to be established. Management of patients who are receiving antiplatelet drugs during the perioperative period requires an understanding of the underlying pathology and rationale for their administration, pharmacology and pharmacokinetics, and drug interactions. Furthermore, the risk and benefit assessment of discontinuing or continuing these drugs should be made bearing in mind the proposed surgery and its inherent risk for bleeding complications as well as decisions relating to appropriate use of general or some form of regional anesthesia. In general, the safest approach to prevent thrombosis seems to be continuation of these drugs throughout the perioperative period except where concerns about perioperative bleeding outweigh those associated with the development of thrombotic occlusion. Knowledge of the pharmacodynamics and pharmacokinetics of antiplatelet drugs may allow practitioners to anticipate difficulties associated with drug withdrawal and administration in the perioperative period including the potential for drug interactions. Footnotes Conflict of Interest: See Disclosures at the end of the article. Accepted October 1, 2010. Copyright ? 2011 International Anesthesia Research Society ? Previous | Next Article ?Table of Contents This Article Published online before print January 6, 2011, doi: 10.1213/?ANE.0b013e318203f38d A & A February 2011 vol. 112 no. 2 292-318 ? Abstract Full Text Full Text (PDF) CME Classifications Series: Review Article Cardiovascular Anesthesiology Services Email this article to a colleague Alert me when this article is cited Alert me if a correction is posted Similar articles in this journal Similar articles in PubMed Download to citation manager Request Permissions Citing Articles Load citing article information Google Scholar Articles by Hall, R. Articles by Mazer, C. D. PubMed PubMed citation Articles by Hall, R. Articles by Mazer, C. D. Related Content Cardiovascular Blood Coagulation Pharmacology Load related web page information Current Issue July 2011, 113 (1) Alert me to new issues of A & A Join the IARS About A&A Mission Editorial Board For Authors For Reviewers Cover Art Sign up Sign up for eTOCs Sign up for RSS feeds Browse by Topic Permissions and Copyright Press Room OpenAnesthesia Advertise in A&A Career Center Most Read Special Article: 2010 Anesthesia & Analgesia Guide for Authors: 2009-2010 Editorial Board, Anesthesia & Analgesia Hand Contamination of Anesthesia Providers Is an Important Risk Factor for Intraoperative Bacterial Transmission Postoperative Sore Throat: More Answers Than Questions Nitrous Oxide and Long-Term Morbidity and Mortality in the ENIGMA Trial Surgical Site Infections and the Anesthesia Professionals' Microbiome: We've All Been Slimed! Now What Are We Going to Do About It? ? View all Most Read articles Cited ASE/SCA Guidelines for Performing a Comprehensive Intraoperative Multiplane Transesophageal Echocardiography Examination: Recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials Consensus Guidelines for Managing Postoperative Nausea and Vomiting Cerebral Autoregulation and Flow/Metabolism Coupling during Cardiopulmonary Bypass: The Influence of Paco2 A Postanesthetic Recovery Score ? View all Most Cited articles Copyright ? 2011 by the International Anesthesia Research Society Print ISSN: 0003-2999 Online ISSN: 1526-7598

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Review article: any antiplatelet drugs: a review of its Pharmacology and management during perioperative period

Any antiplatelet drugs: a review of its Pharmacology and management during perioperative period Go to main page content current issue past issues home CME subscribe ONLINE using the send to (A) and an activating my account search go advanced search? user name password characters in Antiplatelet drugs: A review of their Pharmacology and management in the perioperative Period of Richard Hall, MD, FRCPC, FCCP * and c. David Mazer, MD, FRCPC ? ?

From the *Departments of Anesthesia, Medicine, Surgery, and Pharmacology, Dalhousie University/Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia; ?Keenan Research Center/Li Ka Shing Knowledge Translation Institute, Saint Michael's Hospital, Toronto; and ?Departments of Anesthesia and Physiology, University of Toronto, Toronto, Ontario, Canada. Address correspondence and reprint requests to C. David Mazer, MD, FRCPC, Department of Anesthesia, St. Michael's Hospital, 30 Bond St., Toronto, ON M5B 1W8, Canada. Address e-mail to mazerd{at}smh.ca. Abstract In the normal course of the delivery of care, anesthesiologists encounter many patients who are receiving drugs that affect platelet function as a fundamental part of primary and secondary management of atherosclerotic thrombotic disease. There are several antiplatelet drugs available for use in clinical practice and several under investigation. Aspirin and clopidogrel (alone and in combination) have been the most studied and have the most favorable risk-benefit profiles of drugs currently available. Prasugrel was recently approved for patients with acute coronary syndrome undergoing percutaneous interventions. Other drugs such as dipyridamole and cilostazol have not been as extensively investigated. There are several newer investigational drugs such as cangrelor and ticagrelor, but whether they confer significant additional benefits remains to be established. Management of patients who are receiving antiplatelet drugs during the perioperative period requires an understanding of the underlying pathology and rationale for their administration, pharmacology and pharmacokinetics, and drug interactions. Furthermore, the risk and benefit assessment of discontinuing or continuing these drugs should be made bearing in mind the proposed surgery and its inherent risk for bleeding complications as well as decisions relating to appropriate use of general or some form of regional anesthesia. In general, the safest approach to prevent thrombosis seems to be continuation of these drugs throughout the perioperative period except where concerns about perioperative bleeding outweigh those associated with the development of thrombotic occlusion. Knowledge of the pharmacodynamics and pharmacokinetics of antiplatelet drugs may allow practitioners to anticipate difficulties associated with drug withdrawal and administration in the perioperative period including the potential for drug interactions. Footnotes Conflict of Interest: See Disclosures at the end of the article. Accepted October 1, 2010. Copyright ? 2011 International Anesthesia Research Society ? Previous | Next Article ?Table of Contents This Article Published online before print January 6, 2011, doi: 10.1213/?ANE.0b013e318203f38d A & A February 2011 vol. 112 no. 2 292-318 ? Abstract Full Text Full Text (PDF) CME Classifications Series: Review Article Cardiovascular Anesthesiology Services Email this article to a colleague Alert me when this article is cited Alert me if a correction is posted Similar articles in this journal Similar articles in PubMed Download to citation manager Request Permissions Citing Articles Load citing article information Google Scholar Articles by Hall, R. Articles by Mazer, C. D. PubMed PubMed citation Articles by Hall, R. Articles by Mazer, C. D. Related Content Cardiovascular Blood Coagulation Pharmacology Load related web page information Current Issue June 2011, 112 (6) Alert me to new issues of A & A Join the IARS About A&A Mission Editorial Board For Authors For Reviewers Cover Art Sign up Sign up for eTOCs Sign up for RSS feeds Browse by Topic Permissions and Copyright Press Room OpenAnesthesia Advertise in A&A Career Center Most Read Special Article: 2010 Anesthesia & Analgesia Guide for Authors: 2009-2010 Editorial Board, Anesthesia & Analgesia Hand Contamination of Anesthesia Providers Is an Important Risk Factor for Intraoperative Bacterial Transmission Postoperative Sore Throat: More Answers Than Questions Nitrous Oxide and Long-Term Morbidity and Mortality in the ENIGMA Trial Surgical Site Infections and the Anesthesia Professionals' Microbiome: We've All Been Slimed! Now What Are We Going to Do About It? ? View all Most Read articles Cited ASE/SCA Guidelines for Performing a Comprehensive Intraoperative Multiplane Transesophageal Echocardiography Examination: Recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials Consensus Guidelines for Managing Postoperative Nausea and Vomiting Cerebral Autoregulation and Flow/Metabolism Coupling during Cardiopulmonary Bypass: The Influence of Paco2 A Postanesthetic Recovery Score ? View all Most Cited articles Copyright ? 2011 by the International Anesthesia Research Society Print ISSN: 0003-2999 Online ISSN: 1526-7598

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Review article: the role of the perioperative period of recurrence after Cancer Surgery

The role of the perioperative period of recurrence after Cancer Surgery Go to main page content current issue past issues home CME subscribe ONLINE using the send to (A) and an activating my account search go advanced search? user name, password, character in the role of the perioperative period of recurrence after Cancer Surgery Antje Gottschalk, MD *, ?, Songal Sharma, MD *, Justin Ford, MD *, Marcel e. Durieux, MD, PhD * and Mohamed Tiouririne, MD *

From the *Department of Anesthesia, University of Virginia, Charlottesville, Virginia; and ?Department of Anesthesiology and Intensive Care Medicine, University Muenster, Muenster, Germany. Address correspondence to Mohamed Tiouririne, MD, Department of Anesthesiology, University of Virginia, Charlottesville, VA. Address e-mail to mt9y{at}virginia.edu. Abstract A wealth of basic science data supports the hypothesis that the surgical stress response increases the likelihood of cancer dissemination and metastasis during and after cancer surgery. Anesthetic management of the cancer patient, therefore, could potentially influence long-term outcome. Preclinical data suggest that beneficial approaches might include selection of induction drugs such as propofol, minimizing the use of volatile anesthetics, and coadministration of cyclooxygenase antagonists with systemic opioids. Retrospective clinical trials suggest that the addition of regional anesthesia might decrease recurrence after cancer surgery. Other factors such as blood transfusion, temperature regulation, and statin administration may also affect long-term outcome. Footnotes Marcel E. Durieux is section Editor of Anesthetic Pre-Clinical Pharmacology for the Journal. The manuscript was handled by Sorin J. Brull, section Editor of Patient Safety, and Dr. Durieux was not involved in any way with the editorial process or decision. Disclosure: The authors report no conflict of interest. Reprints will not be available from the author. Accepted February 24, 2010. Copyright ? 2010 International Anesthesia Research Society ? Previous | Next Article ?Table of Contents This Article Published online before print April 30, 2010, doi: 10.1213/?ANE.0b013e3181de0ab6 A & A June 2010 vol. 110 no. 6 1636-1643 ? Abstract Full Text Full Text (PDF) CME Classifications Series: Review Article Patient Safety Services Email this article to a colleague Alert me when this article is cited Alert me if a correction is posted Similar articles in this journal Similar articles in PubMed Download to citation manager Request Permissions Citing Articles Load citing article information Citing articles via Google Scholar Google Scholar Articles by Gottschalk, A. Articles by Tiouririne, M. Search for related content PubMed PubMed citation Articles by Gottschalk, A. Articles by Tiouririne, M. Related Content Mechanisms Outcomes Patient Safety Pharmacology Load related web page information Current Issue June 2011, 112 (6) Alert me to new issues of A & A Join the IARS About A&A Mission Editorial Board For Authors For Reviewers Cover Art Sign up Sign up for eTOCs Sign up for RSS feeds Browse by Topic Permissions and Copyright Press Room OpenAnesthesia Advertise in A&A Career Center Most Read Special Article: 2010 Anesthesia & Analgesia Guide for Authors: 2009-2010 Editorial Board, Anesthesia & Analgesia Hand Contamination of Anesthesia Providers Is an Important Risk Factor for Intraoperative Bacterial Transmission Review Article: The Role of the Perioperative Period in Recurrence After Cancer Surgery Postoperative Sore Throat: More Answers Than Questions Electrical Safety in the Operating Room: Dry Versus Wet ? View all Most Read articles Cited The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials ASE/SCA Guidelines for Performing a Comprehensive Intraoperative Multiplane Transesophageal Echocardiography Examination: Recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography Consensus Guidelines for Managing Postoperative Nausea and Vomiting Cerebral Autoregulation and Flow/Metabolism Coupling during Cardiopulmonary Bypass: The Influence of Paco2 A Postanesthetic Recovery Score ? View all Most Cited articles Copyright ? 2011 by the International Anesthesia Research Society Print ISSN: 0003-2999 Online ISSN: 1526-7598

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Review article: the role of the perioperative period of recurrence after Cancer Surgery

The role of the perioperative period of recurrence after Cancer Surgery Go to main page content current issue past issues home CME subscribe ONLINE using the send to (A) and an activating my account search go advanced search? user name, password, character in the role of the perioperative period of recurrence after Cancer Surgery Antje Gottschalk, MD *, ?, Songal Sharma, MD *, Justin Ford, MD *, Marcel e. Durieux, MD, PhD * and Mohamed Tiouririne, MD *

From the *Department of Anesthesia, University of Virginia, Charlottesville, Virginia; and ?Department of Anesthesiology and Intensive Care Medicine, University Muenster, Muenster, Germany. Address correspondence to Mohamed Tiouririne, MD, Department of Anesthesiology, University of Virginia, Charlottesville, VA. Address e-mail to mt9y{at}virginia.edu. Abstract A wealth of basic science data supports the hypothesis that the surgical stress response increases the likelihood of cancer dissemination and metastasis during and after cancer surgery. Anesthetic management of the cancer patient, therefore, could potentially influence long-term outcome. Preclinical data suggest that beneficial approaches might include selection of induction drugs such as propofol, minimizing the use of volatile anesthetics, and coadministration of cyclooxygenase antagonists with systemic opioids. Retrospective clinical trials suggest that the addition of regional anesthesia might decrease recurrence after cancer surgery. Other factors such as blood transfusion, temperature regulation, and statin administration may also affect long-term outcome. Footnotes Marcel E. Durieux is section Editor of Anesthetic Pre-Clinical Pharmacology for the Journal. The manuscript was handled by Sorin J. Brull, section Editor of Patient Safety, and Dr. Durieux was not involved in any way with the editorial process or decision. Disclosure: The authors report no conflict of interest. Reprints will not be available from the author. Accepted February 24, 2010. Copyright ? 2010 International Anesthesia Research Society ? Previous | Next Article ?Table of Contents This Article Published online before print April 30, 2010, doi: 10.1213/?ANE.0b013e3181de0ab6 A & A June 2010 vol. 110 no. 6 1636-1643 ? Abstract Full Text Full Text (PDF) CME Classifications Series: Review Article Patient Safety Services Email this article to a colleague Alert me when this article is cited Alert me if a correction is posted Similar articles in this journal Similar articles in PubMed Download to citation manager Request Permissions Citing Articles Load citing article information Citing articles via Google Scholar Google Scholar Articles by Gottschalk, A. Articles by Tiouririne, M. Search for related content PubMed PubMed citation Articles by Gottschalk, A. Articles by Tiouririne, M. Related Content Mechanisms Outcomes Patient Safety Pharmacology Load related web page information Current Issue June 2011, 112 (6) Alert me to new issues of A & A Join the IARS About A&A Mission Editorial Board For Authors For Reviewers Cover Art Sign up Sign up for eTOCs Sign up for RSS feeds Browse by Topic Permissions and Copyright Press Room OpenAnesthesia Advertise in A&A Career Center Most Read Special Article: 2010 Anesthesia & Analgesia Guide for Authors: 2009-2010 Editorial Board, Anesthesia & Analgesia Hand Contamination of Anesthesia Providers Is an Important Risk Factor for Intraoperative Bacterial Transmission Review Article: The Role of the Perioperative Period in Recurrence After Cancer Surgery Postoperative Sore Throat: More Answers Than Questions Electrical Safety in the Operating Room: Dry Versus Wet ? View all Most Read articles Cited The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials ASE/SCA Guidelines for Performing a Comprehensive Intraoperative Multiplane Transesophageal Echocardiography Examination: Recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography Consensus Guidelines for Managing Postoperative Nausea and Vomiting Cerebral Autoregulation and Flow/Metabolism Coupling during Cardiopulmonary Bypass: The Influence of Paco2 A Postanesthetic Recovery Score ? View all Most Cited articles Copyright ? 2011 by the International Anesthesia Research Society Print ISSN: 0003-2999 Online ISSN: 1526-7598

View the original article here