Managing Patients on Antiplatelet Drugs Requiring Emergency Non‐Cardiac Surgery

Background: The antiplatelet drugs, aspirin and clopidogrel, are widely prescribed for cardiovascular and neurovascular diseases. It is recommended that these drugs should be ceased 5 days prior to elective surgery. If patients on these drugs require emergency non-cardiac surgery, the peri-operative risk of haemorrhage and thrombosis causes management dilemmas. Current guidelines are limited to the management of patients with coronary stents who are on antiplatelet drugs and require elective surgery. There is no universal evidence-based consensus, for the indications, method, timing or endpoints of treatment to reverse the antiplatelet action of clopidogrel in patients requiring emergency non-cardiac surgery. Aim: To report two cases where emergency abdominal surgery was required in patients on concomitant clopidogrel and aspirin. Clinical details and outcome: Two patients who were on concomitant aspirin and clopidogrel required urgent abdominal surgery. The two cases were managed differently. In the first case, no pre-operative platelets or fresh frozen plasma were administered and surgery was complicated by major bleeding. The second patient received pre-operative platelet transfusion and encountered no significant bleeding or thrombotic complications. Conclusion: There is an urgent need for the development of guidelines to manage patients receiving antiplatelet drugs requiring emergency non-cardiac surgery.