Hantering av trombocythämmare i samband med kirurgi. Trombocytfunktionstest kan bidra till kloka beslut
Sammanfattning
A considerable proportion of patients with ischemic heart disease on dual antiplatelet therapy need to undergo surgery. Since the new antiplatelet drugs ticagrelor and prasugrel both inhibit platelet aggregation to a greater extent than clopidogrel, they thereby also increase the risk of surgery-associated bleeding. However, preoperative withdrawal of antiplatelet therapy to minimize surgical bleeding increases the risk of thrombotic complications. The experiences gathered from the management of antiplatelet therapy in cardiac surgery can be applied to non-cardiac surgery. The decision to continue or withdraw antiplatelet therapy before surgery should be made together with a cardiologist. Point-of-care testing of clopidogrel-induced platelet inhibition can provide guidance, but requires good knowledge about the test used. In the case of high adenosine diphosphate (ADP)-induced platelet reactivity, the perioperative bleeding risk is not increased. Low platelet reactivity and ongoing bleeding are indications for platelet transfusions and possibly also aprotinin. Ticagrelor-related bleeding may be more difficult to counteract.