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Tthe other major message from the revised CABG guidelines is a new approach to dealing with antiplatelet therapies in the days leading up to cardiac surgery, said Dr. Peter K. Smith, vice-chairman of the CABG guidelines committee.
"There is a growing body of evidence that patients benefit from these agents," the P2Y12-receptor binding drug class of clopidogrel (Plavix), prasugrel (Effient), and ticagrelor (Brilinta). "Our guidelines emphasize that surgery can be safely done in the presence of some of these platelet inhibitors when necessary," he said in an interview. "There is reluctance against doing surgery in the presence of these drugs that is to the disadvantage of patients."
Specifically, the new guidelines say that in patients referred for urgent CABG, clopidogrel and ticagrelor should be discontinued to at least 24 hours to reduce major bleeding complications. Stoppage scheduled 1 day before surgery is a significant scaling down from the prior recommendation that clopidogrel be halted at least 5 days before surgery, he said. "Surgeons need to be more permissive about having this [antiplatelet] environment in place when surgery is performed."
The new guidelines add that for patients undergoing elective CABG, clopidogrel or ticagrelor treatment should stop at least 5 days before surgery, and prasugrel treatment should stop for at least 7 days. This more conservative approach makes sense when patients are not unstable and in a prothrombotic state, Dr. Smith said.
The guidelines also update the presurgical approach to aspirin treatment. Aspirin should be administered preoperatively, at 100-325 mg/day, right up to surgery. Prior guidelines called for stopping aspirin several days before. The new guidelines recommend if aspirin was not administered preoperatively, it should be initiated within 6 hours after surgery and then continued indefinitely. Clopidogrel should be used in patients allergic to or intolerant of aspirin.
–Mitchel L. Zoler
Tthe other major message from the revised CABG guidelines is a new approach to dealing with antiplatelet therapies in the days leading up to cardiac surgery, said Dr. Peter K. Smith, vice-chairman of the CABG guidelines committee.
"There is a growing body of evidence that patients benefit from these agents," the P2Y12-receptor binding drug class of clopidogrel (Plavix), prasugrel (Effient), and ticagrelor (Brilinta). "Our guidelines emphasize that surgery can be safely done in the presence of some of these platelet inhibitors when necessary," he said in an interview. "There is reluctance against doing surgery in the presence of these drugs that is to the disadvantage of patients."
Specifically, the new guidelines say that in patients referred for urgent CABG, clopidogrel and ticagrelor should be discontinued to at least 24 hours to reduce major bleeding complications. Stoppage scheduled 1 day before surgery is a significant scaling down from the prior recommendation that clopidogrel be halted at least 5 days before surgery, he said. "Surgeons need to be more permissive about having this [antiplatelet] environment in place when surgery is performed."
The new guidelines add that for patients undergoing elective CABG, clopidogrel or ticagrelor treatment should stop at least 5 days before surgery, and prasugrel treatment should stop for at least 7 days. This more conservative approach makes sense when patients are not unstable and in a prothrombotic state, Dr. Smith said.
The guidelines also update the presurgical approach to aspirin treatment. Aspirin should be administered preoperatively, at 100-325 mg/day, right up to surgery. Prior guidelines called for stopping aspirin several days before. The new guidelines recommend if aspirin was not administered preoperatively, it should be initiated within 6 hours after surgery and then continued indefinitely. Clopidogrel should be used in patients allergic to or intolerant of aspirin.
–Mitchel L. Zoler
Tthe other major message from the revised CABG guidelines is a new approach to dealing with antiplatelet therapies in the days leading up to cardiac surgery, said Dr. Peter K. Smith, vice-chairman of the CABG guidelines committee.
"There is a growing body of evidence that patients benefit from these agents," the P2Y12-receptor binding drug class of clopidogrel (Plavix), prasugrel (Effient), and ticagrelor (Brilinta). "Our guidelines emphasize that surgery can be safely done in the presence of some of these platelet inhibitors when necessary," he said in an interview. "There is reluctance against doing surgery in the presence of these drugs that is to the disadvantage of patients."
Specifically, the new guidelines say that in patients referred for urgent CABG, clopidogrel and ticagrelor should be discontinued to at least 24 hours to reduce major bleeding complications. Stoppage scheduled 1 day before surgery is a significant scaling down from the prior recommendation that clopidogrel be halted at least 5 days before surgery, he said. "Surgeons need to be more permissive about having this [antiplatelet] environment in place when surgery is performed."
The new guidelines add that for patients undergoing elective CABG, clopidogrel or ticagrelor treatment should stop at least 5 days before surgery, and prasugrel treatment should stop for at least 7 days. This more conservative approach makes sense when patients are not unstable and in a prothrombotic state, Dr. Smith said.
The guidelines also update the presurgical approach to aspirin treatment. Aspirin should be administered preoperatively, at 100-325 mg/day, right up to surgery. Prior guidelines called for stopping aspirin several days before. The new guidelines recommend if aspirin was not administered preoperatively, it should be initiated within 6 hours after surgery and then continued indefinitely. Clopidogrel should be used in patients allergic to or intolerant of aspirin.
–Mitchel L. Zoler