Any antiplatelet drugs: a review of its Pharmacology and management during perioperative period
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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) 
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