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 articles: Lumbar ryggmärgsvätskan River system of Thoracoabdominal colorectal surgery: rationale and practical considerations for management

Lumbar ryggm?rgsv?tskan River system of Thoracoabdominal colorectal surgery: rationale and practical considerations for management 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 sign in lumbar ryggm?rgsv?tskan River system of Thoracoabdominal colorectal surgery: rationale and practical considerations for managing Christine a. Fedorow, MD *, Michael c. Moon, MD, FRCPC ?, w. Alan c. Mutch, MD, FRCPC * and Hilary p. GrocottVD, FRCPC * ?

From the Departments of *Anesthesia and ?Surgery, University of Manitoba, Winnipeg, Manitoba, Canada. Address correspondence and reprint requests to Hilary P. Grocott, MD, FRCPC, Departments of Anesthesia, University of Manitoba, I.H. Asper Institute for Clinical Research, CR3008-369 Tache Ave., Winnipeg, MB, Canada R2H 2A6. Address e-mail to hgrocott{at}sbgh.mb.ca. Abstract Paraplegia remains one of the most devastating complications of thoracoabdominal aortic surgery and is associated with a significant increase in both morbidity and mortality. Modern aortic repair techniques use many modalities aimed at reducing the risk of spinal cord ischemia inherent with surgical management. One of these modalities that acts via optimizing spinal cord blood flow is lumbar cerebrospinal fluid (CSF) drainage. Either alone or in combination with other interventions, CSF drainage remains one of the most frequently used spinal cord protection techniques. Despite no definitive proof of efficacy for reducing spinal cord injury, there are compelling data supporting its use. However, the potential benefit of CSF drainage must be balanced against the risks associated with its use, including nerve injury during insertion, compressive neuraxial hematoma formation, intracranial hemorrhage due to excessive drainage, and infection. The optimal benefit to risk ratio can be achieved by understanding the rationale for its use and following practical management guidelines. Footnotes Supported by internal departmental funding. Disclosure: The authors report no conflicts of interest. Copyright ? 2010 International Anesthesia Research Society ? Previous | Next Article ?Table of Contents This Article Published online before print June 3, 2010, doi: 10.1213/?ANE.0b013e3181ddddd6 A & A July 2010 vol. 111 no. 1 46-58 ? Abstract Full Text Full Text (PDF) CME Classifications Series: Review Articles 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 Citing articles via Google Scholar Google Scholar Articles by Fedorow, C. A. Articles by Grocott, H. P. Search for related content PubMed PubMed citation Articles by Fedorow, C. A. Articles by Grocott, H. P. Related Content Cardiovascular Neuroanesthesia Anesthetic Techniques Patient Safety 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 articles: Lumbar ryggmärgsvätskan drainage for Thoracoabdominal colorectal surgery: rationale and practical considerations for management

Lumbar ryggm?rgsv?tskan drainage for Thoracoabdominal colorectal surgery: rationale and practical considerations for management 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 sign in lumbar ryggm?rgsv?tskan drainage for Thoracoabdominal colorectal surgery: rationale and practical considerations for managing Christine a. Fedorow, MD *, Michael c. Moon, MD, FRCPC ?, w. Alan c. Mutch, MD, FRCPC * and Hilary p. GrocottVD, FRCPC * ?

From the Departments of *Anesthesia and ?Surgery, University of Manitoba, Winnipeg, Manitoba, Canada. Address correspondence and reprint requests to Hilary P. Grocott, MD, FRCPC, Departments of Anesthesia, University of Manitoba, I.H. Asper Institute for Clinical Research, CR3008-369 Tache Ave., Winnipeg, MB, Canada R2H 2A6. Address e-mail to hgrocott{at}sbgh.mb.ca. Abstract Paraplegia remains one of the most devastating complications of thoracoabdominal aortic surgery and is associated with a significant increase in both morbidity and mortality. Modern aortic repair techniques use many modalities aimed at reducing the risk of spinal cord ischemia inherent with surgical management. One of these modalities that acts via optimizing spinal cord blood flow is lumbar cerebrospinal fluid (CSF) drainage. Either alone or in combination with other interventions, CSF drainage remains one of the most frequently used spinal cord protection techniques. Despite no definitive proof of efficacy for reducing spinal cord injury, there are compelling data supporting its use. However, the potential benefit of CSF drainage must be balanced against the risks associated with its use, including nerve injury during insertion, compressive neuraxial hematoma formation, intracranial hemorrhage due to excessive drainage, and infection. The optimal benefit to risk ratio can be achieved by understanding the rationale for its use and following practical management guidelines. Footnotes Supported by internal departmental funding. Disclosure: The authors report no conflicts of interest. Copyright ? 2010 International Anesthesia Research Society ? Previous | Next Article ?Table of Contents This Article Published online before print June 3, 2010, doi: 10.1213/?ANE.0b013e3181ddddd6 A & A July 2010 vol. 111 no. 1 46-58 ? Abstract Full Text Full Text (PDF) CME Classifications Series: Review Articles 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 Citing articles via Google Scholar Google Scholar Articles by Fedorow, C. A. Articles by Grocott, H. P. Search for related content PubMed PubMed citation Articles by Fedorow, C. A. Articles by Grocott, H. P. Related Content Cardiovascular Neuroanesthesia Anesthetic Techniques Patient Safety 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: 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

View the original article here