Urological Surgery and Antiplatelet Drugs After Cardiac and Cerebrovascular Accidents

No AccessJournal of UrologyReview Article1 Jun 2010Urological Surgery and Antiplatelet Drugs After Cardiac and Cerebrovascular Accidents Daniel Eberli, Pierre-Guy Chassot, Tullio Sulser, Charles Marc Samama, Jean Mantz, Alain Delabays, and Donat R. Spahn Daniel EberliDaniel Eberli Urology Clinic, University Hospital Zürich, Zürich, Switzerland , Pierre-Guy ChassotPierre-Guy Chassot Department of Biology and Medicine, University Hospital Lausanne, Lausanne, Switzerland , Tullio SulserTullio Sulser Urology Clinic, University Hospital Zürich, Zürich, Switzerland , Charles Marc SamamaCharles Marc Samama Department of Anaesthesiology and Intensive Care, Hotel-Dieu University Hospital, Paris, France , Jean MantzJean Mantz Department of Anaesthesiology and Critical Care, Beaujon & Louis Mourier University Hospitals, Clichy, France , Alain DelabaysAlain Delabays Department of Cardiology, University Hospital Lausanne, Lausanne, Switzerland , and Donat R. SpahnDonat R. Spahn Institute of Anaesthesiology, University Hospital Zürich, Zürich, Switzerland View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2391AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The perioperative treatment of patients on dual antiplatelet therapy after myocardial infarction, cerebrovascular event or coronary stent implantation represents an increasingly frequent issue for urologists and anesthesiologists. We assess the current scientific evidence and propose strategies concerning treatment of these patients. Materials and Methods: A MEDLINE® and PubMed® search was conducted for articles related to antiplatelet therapy after myocardial infarction, coronary stents and cerebrovascular events, as well as the use of aspirin and/or clopidogrel in the context of surgery. Results: Early discontinuation of antiplatelet therapy for secondary prevention is associated with a high risk of coronary thrombosis, which is further increased by the hypercoagulable state induced by surgery. Aspirin has recently been recommended as a lifelong therapy. Clopidogrel is mandatory for 6 weeks after myocardial infarction and bare metal stents, and for 12 months after drug-eluting stents. Surgery must be postponed beyond these waiting periods or performed with patients receiving dual antiplatelet therapy because withdrawal therapy increases 5 to 10 times the risk of postoperative myocardial infarction, stent thrombosis or death. The shorter the waiting period between revascularization and surgery the greater the risk of adverse cardiac events. The risk of surgical hemorrhage is increased approximately 20% by aspirin and 50% by clopidogrel. Conclusions: The risk of coronary thrombosis when antiplatelet agents are withdrawn before surgery is generally higher than the risk of surgical hemorrhage when antiplatelet agents are maintained. However, this issue has not yet been sufficiently evaluated in urological patients and in many instances during urological surgery the risk of bleeding can be dangerous. A thorough dialogue among surgeon, cardiologist and anesthesiologist is essential to determine all risk factors and define the best possible strategy for each patient. References 1 : Urologists: be aware of significant risks to stopping anticoagulants in patients with drug-eluting coronary stents. BJU Int2007; 99: 1330. Google Scholar 2 : Late coronary stent thrombosis complicating urologic surgery. Eur Urol2008; 54: 221. Google Scholar 3 : Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ2002; 324: 71. 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Google Scholar © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byIto T, Derweesh I, Ginzburg S, Abbosh P, Raheem O, Mirheydar H, Hamilton Z, Chen D, Smaldone M, Greenberg R, Viterbo R, Kutikov A and Uzzo R (2016) Perioperative Outcomes Following Partial Nephrectomy Performed on Patients Remaining on Antiplatelet TherapyJournal of Urology, VOL. 197, NO. 1, (31-36), Online publication date: 1-Jan-2017.Culkin D, Exaire E, Green D, Soloway M, Gross A, Desai M, White J and Lightner D (2014) Anticoagulation and Antiplatelet Therapy in Urological Practice: ICUD/AUA Review PaperJournal of Urology, VOL. 192, NO. 4, (1026-1034), Online publication date: 1-Oct-2014. Volume 183Issue 6June 2010Page: 2128-2136 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.Keywordsplatelet aggregation inhibitorsblood lossstentsmyocardial revascularizationsurgicalMetricsAuthor Information Daniel Eberli Urology Clinic, University Hospital Zürich, Zürich, Switzerland Nothing to disclose. More articles by this author Pierre-Guy Chassot Department of Biology and Medicine, University Hospital Lausanne, Lausanne, Switzerland Nothing to disclose. More articles by this author Tullio Sulser Urology Clinic, University Hospital Zürich, Zürich, Switzerland Nothing to disclose. More articles by this author Charles Marc Samama Department of Anaesthesiology and Intensive Care, Hotel-Dieu University Hospital, Paris, France Nothing to disclose. More articles by this author Jean Mantz Department of Anaesthesiology and Critical Care, Beaujon & Louis Mourier University Hospitals, Clichy, France Nothing to disclose. More articles by this author Alain Delabays Department of Cardiology, University Hospital Lausanne, Lausanne, Switzerland Nothing to disclose. More articles by this author Donat R. Spahn Institute of Anaesthesiology, University Hospital Zürich, Zürich, Switzerland Financial interest and/or other relationship with Abbot, Alliance Pharmaceutical Corp., AstraZeneca, Bayer, Boehringer Ingelheim, CSL Behring, Fresenius, Galencia, GlaxoSmithKline, Janssen-Cilag, Novo Nordisk, Octapharma, Organon, Pentapharm, Roche Pharma and Schering-Plough International. More articles by this author Expand All Advertisement PDF downloadLoading ...