Antiplatelet agents in perioperative noncardiac surgeries: to maintain or to suspend?

Figures & data

Table 1 Description of each included RCT: country, population, type of surgery, description of control group, and outcomes measures

Authors, year, country	Populationa (n)	Mean age	Type of surgery	Use of antiplatelet agents		Results	Limitations of the study	Conclusions
				Yes	No
Bajkin et al,^Citation23 2015, Serbia	n=160	61	Small dental surgical procedures	x		The incidence of postoperative bleeding did not differ significantly between the three groups.	Small sample size and procedures with low bleeding risk (single and multiple extractions).	Patients using single or double antiplatelet therapy may have teeth extracted safely without interruption of treatment.
Girotra et al,^Citation24 2014, India	n=1,121	40–75 (age range)	Small dental surgical procedures	x		Prolonged bleeding in patients with antiplatelet therapy regardless of the type of surgery. The increased risk of prolonged bleeding was found in patients with dual therapy and required higher levels of hemostatic measures.	The platelet aggregation test was not used because it is expensive. In addition, intraoperative bleeding was not quantified to estimate and compare between the study group and the control group.	There was no need for blood transfusion for any patient. Therefore, there is no exposure of the patient to the risk of thromboembolism, cerebrovascular accidents, or myocardial or renal infarction, interrupting antiplatelet therapy before small oral surgical procedures, which could cost the patient his life.
Picozzi et al,^Citation25 2014, United States of America	n=213	71	Transurethral bladder cancer resections	x		Three patients in the treatment group and two patients in the control group required reintervention to ensure hemostasis during the postoperative period. None of patients in any group were subjected to rehospitalization because of hematuria after leaving the hospital.	Not reported.	The results suggest that continued use of antiaggregant monotherapy does not increase the risk of general bleeding or reintervention for patients undergoing transurethral resection of bladder neoplasms and that suspending aspirin prior to such a procedure is therefore unnecessary.
Varghese et al,^Citation22 2015, India	n=190	62	Dental extraction	x		None of the patients in any of the groups presented significant uncontrollable bleeding after extraction.	Not reported.	It is recommended to routinely extract individual teeth in patients on long-term antiplatelet medication without interruption or change in their medication. Such patients do not present an increased risk of prolonged or excessive postoperative hemorrhage.

Notes:

a Population reported as intervention group, control group. If not available, the data of the total population will be presented.

Abbreviation: RCT, randomized controlled trial.

Figure 1 Flow diagram for literature searching and screening.

Figure 2 Summary of the bias risk of the four studies.

Notes: +: low risk of bias; -: high risk of bias; ?: uncertain risk of bias.

BajkinBVUrosevicIMStankovKMPetrovicBBBajkinIADental extractions and risk of bleeding in patients taking single and dual antiplatelet treatmentBr J Oral Maxillofac Surg2015531394325311541

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GirotraCPadhyeMMandlikGAssessment of the risk of haemorrhage and its control following minor oral surgical procedures in patients on anti-platelet therapy: a prospective studyInt J Oral Maxillofac Surg20144319910624074486

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PicozziSMarenghiCRicciCRisks and complications of transurethral resection of bladder tumor among patients taking anti-platelet agents for cardiovascular diseaseSurg Endosc201428111612124002913

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VargheseKGManoharanSSadhanandanMEvaluation of bleeding following dental extraction in patients on long-term antiplatelet therapy: A clinical trialIndian J Dent Res201526325225526275190

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