How to monitor antiplatelet drugs before non-cardiac surgery ?

Antiplatelet drugs such as aspirin or clopidogrel reduce the risk of people getting the blood clot and are routinely prescribed for people who have had coronary stents inserted. They are also recommended for people with unstable angina or heart disease or people who have had a heart attack, heart surgery or a stroke.

Taking antiplatelet therapy introduces an increased risk of bleeding, which could lead to problems if a person needs non-cardiac surgery. Stopping usual antiplatelet therapy a few days before surgery might reduce the risk of serious bleeding during surgery. Not taking these antiplatelet drugs could, however, increase the risk of a heart attack, stroke, or death.

Lewis SR and his associates conducted a study to determine whether continuing to take antiplatelet drugs before non-cardiac surgery that requires general, spinal or regional anaesthesia increases the risk of experiencing serious bleeding, ischaemic event or death in adults when compared with stopping antiplatelet drugs for at least five days before non-cardiac surgery.

The investigators collected data from randomized controlled trials which included five trials with 666 adults in the review. Three studies are ongoing. All participants were taking antiplatelet therapy (aspirin or clopidogrel) at the start of the study. Two studies stopped antiplatelet drugs for at least five days before surgery, and three studies gave participants a placebo instead of antiplatelet therapy during this time.

Read ALso: Clot-busting drugs not recommended for most patients with blood clots

Key findings:

• Low-certainty evidence that either continuing or stopping antiplatelet therapy may make little or no difference to the number of people who died up to 30 days or six months after surgery (five studies, 659 participants).


• Moderate-certainty evidence that either continuing or stopping antiplatelet therapy probably makes little or no difference to incidences of bleeding serious enough to need a blood transfusion during or immediately after surgery (four studies, 368 participants).


• Low-certainty evidence that either continuing or stopping antiplatelet therapy may make little or no difference to bleeding serious enough to need further surgery (four studies, 368 participants), and may make little or no difference to the number of ischaemic events such as stroke or heart attack (four studies, 616 participants).

The findings of the study were published in Cochrane.

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