Gestion périopératoire des agents antiplaquettaires chez le patient coronarien

The management of antiplatelet agents (APA) in the peri-operative setting is a common problem, balancing bleeding risk and thrombotic risk. The procedure-associated bleeding risk is stratified in a 3-tiered risk scheme: procedures with low, intermediate and high bleeding risk could be performed after discontinuation of none, one or both APA respectively. If discontinuation of APA is absolutely necessary, this should be as short as possible: aspirin: 3 days, ticagrelor and clopidogrel: 5 days, prasugrel: 7 days. Thrombotic risk is higher after coronary stent placement and myocardial infarction. In such situations, the risk declined over time thus delaying procedure is important, ideally up to the end of the dual antiplatelet therapy, and at least to the end of the first month. Aspirin should not be stopped. Decisions regarding APA antiplatelet therapy would be best made in a multidisciplinary fashion, especially in high-risk patients.