Non cardiac surgery မလုပ်ခင် Antiplatelets တွေကို ရပ်ရမှာလား ဆက်ပေးရမှာလား အတွက်ကို 2022 ESC guidelines on cardiovascular assessment and management of patients undergoing non cardiac surgery ကနေ ကောက်နုတ်ဖော်ပြပေးလိုက်ပါတယ်။
For the bleeding risk according to types of surgery – see photo below
For patients using aspirin for primary prevention
• In patients taking aspirin for primary prevention, the risk of ischemic events is low and aspirin can be withdrawn prior to non-cardiac surgery. (usually 72 or more hours before surgery)
• Permanent discontinuation should be considered postoperatively in low- and moderate-risk atherosclerotic cardiovascular disease risk patients and/or in patients with high bleeding risk.
For patients using aspirin for secondary prevention (i.e. in patients with previous cardiovascular diseases)
• In the patients who have undergone PCI, the ischemic benefit of peri operative aspirin use outweighs the bleeding risk, and so aspirin should be continued during perioperative period unless there is a very high bleeding risk.
• For the patient with high perioperative bleeding risk (e.g. in spinal surgery, certain neurosurgical or ophthalmological operations), aspirin should be discontinued for at least 7 days.
For patients using P2Y12 inhibitor (e.g. clopidogrel) monotherapy for chronic coronary syndrome
• Short interruption of P2Y12 inhibitor is recommended in patients with high risk of bleeding. (duration of stoppage before operation is shown in photo below)
For the perioperative management of patients on dual antiplatelet therapy – see photo below
For full guideline link
https://academic.oup.com/eurheartj/article/43/39/3826/6675076
