Gestion des agents antiplaquettaires avant chirurgie élective

Management of antiplatelet agents before elective surgery To consider antiplatelet agents during preoperative anesthetic visit, the anesthesist needs the following information: the type of antiplatelet agents, the reason and the time of prescription, the consultant's name, the precise description of the surgery and the date when it is done. To continue or to stop the antiplatelet agents before surgery will depend on these data. Aspirin as primary prevention must be stopped 5 days before surgery; in secondary prevention, it may be continued except in surgeries presenting a high risk of haemorrhage [intracranial surgery, rachidial surgery (medullary ductus), tonsil surgery, eye posterior segment surgery, prostatic resection surgery, or any other surgery for which haemorrhagic risk would be greater than thrombotic one]. For patients taking both aspirin and clopidogrel, it is necessary to determine if they are in a period of low or high atherothrombotic risk. In low risk patients, clopidogrel is stopped 5 days before surgery, and aspirin is continued except in surgeries involving a high haemorrhagic risk. Concerning patients with high atherothrombotic risks, a careful attention is required for those having a DES stent, and in all cases, this needs a multidisciplinary dialogue between the anesthesist, the surgeon and the consultant because a priori, any surgery has to be postponed, except in an emergency. At the present time, no substitution treatment has been validated.