Perioperative Management of Antithrombotic Therapy in Patients Undergoing Plastic and Reconstructive Surgery: A Practical Tool Based on Current Guidelines

被引:1
作者
Behroozian, Tara [1 ]
Fang, Evan [1 ]
Douketis, James [2 ]
Retrouvey, Helene [3 ]
Thoma, Achilles [3 ,4 ]
机构
[1] McMaster Univ, McMaster Inst Urol, Hamilton, ON, Canada
[2] McMaster Univ, Dept Med, Hamilton, ON, Canada
[3] McMaster Univ, Dept Surg, Div Plast Surg, 206 James St South, Su 101, Hamilton, ON L8P3A9, Canada
[4] Evidence & Impact HEI McMaster Univ, Dept Hlth Res Methods, Hamilton, ON, Canada
关键词
anticoagulants; antiplatelets; antithrombotic therapy; guidelines; perioperative management; plastic surgery; antiplaquettaires; chirurgie plastique; directives; prise en charge p & eacute; riop & eacute; ratoire; traitement antithrombotique; BLEEDING COMPLICATIONS; ORAL ANTICOAGULANTS; AGENTS; ASPIRIN;
D O I
10.1177/22925503241256654
中图分类号
R61 [外科手术学];
学科分类号
摘要
Introduction: Given the aging population, plastic surgeons are increasingly faced with the challenge of balancing procedural bleeding risk with thromboembolic risk in patients receiving antithrombotic therapies undergoing elective procedures. Guideline recommendations remain unclear in this population, which contributes to heterogeneity in clinical practices. We present a practical approach that summarizes guideline recommendations to facilitate the perioperative management of patients requiring surgery who are already on antithrombotic agents. Methods: Due to the scarcity of plastic surgery-specific guidelines, recommendations were primarily adapted from the 2022 American College of Chest Physicians guidelines on perioperative management of antithrombotic therapy as they are recognized as authoritative and widely used in clinical practice. Results: A clinical practice conceptual framework was adapted based on preexisting guidelines, dividing decision-making into 3 steps: (1) assessing the procedural bleeding risk; (2) assessing the patients' thromboembolic risk; and (3) determining appropriate management according to antithrombotic agent type. Specific indications are provided for continuing, stopping, and bridging anticoagulants and antiplatelet agents, as well as for consultation with a cardiologist or hematologist. Conclusion: The present framework can be implemented in plastic surgeons' clinical practice to guide the management of patients on antithrombotic therapies, while minimizing nonessential referrals to the thrombosis service. The lack of plastic surgery-specific guidelines on this topic highlights a need for further research to "bootstrap" the risk categorization of plastic surgical procedures and their appropriate perioperative management. Introduction: Puisque la population est vieillissante, les chirurgiens plastiques doivent de plus en plus soupeser le risque d'h & eacute;morragie pendant l'intervention avec le risque de thromboembolie chez les patients qui prennent des antithrombotiques et subissent une intervention non urgente. Les directives ne sont pas claires au sein de cette population, ce qui contribue & agrave; l'h & eacute;t & eacute;rog & eacute;n & eacute;it & eacute; des pratiques cliniques. Les auteurs pr & eacute;sentent une approche pratique qui r & eacute;sume les directives en vue de faciliter la prise en charge p & eacute;riop & eacute;ratoire des patients qui prennent des antithrombotiques et doivent & ecirc;tre op & eacute;r & eacute;s. M & eacute;thodologie: & Eacute;tant donn & eacute; la raret & eacute; des directives en chirurgie plastique, les recommandations ont majoritairement & eacute;t & eacute; adapt & eacute;es des directives de l'American College of Chest Physicians de 2022 sur la prise en charge p & eacute;riop & eacute;ratoire des antithrombotiques, car elles sont reconnues comme faisant autorit & eacute; et sont largement utilis & eacute;es en pratique clinique. R & eacute;sultats: Les auteurs ont adapt & eacute; un cadre conceptuel utilis & eacute; en pratique clinique & agrave; partir de directives existantes, lequel r & eacute;partit la prise de d & eacute;cision en trois & eacute;tapes : 1) & eacute;valuer le risque d'h & eacute;morragie pendant l'intervention; 2) & eacute;valuer le risque de thromboembolie chez les patients; 3) d & eacute;terminer la prise en charge appropri & eacute;e en fonction du type d'antithrombotique. Des indications pr & eacute;cises sont pr & eacute;sent & eacute;es sur la poursuite, l'arr & ecirc;t et le remplacement temporaire des anticoagulants et des antiplaquettaires, de m & ecirc;me que sur les consultations en cardiologie ou en h & eacute;matologie. Conclusion: Le pr & eacute;sent cadre peut & ecirc;tre mis en oe uvre dans la pratique clinique des chirurgiens plastiques pour orienter la prise en charge des patients qui prennent des antithrombotiques, tout en limitant les consultations non essentielles au service de thrombose. L'absence de directives en chirurgie plastique sur le sujet fait ressortir la n & eacute;cessit & eacute; de poursuivre les recherches pour parvenir & agrave; une cat & eacute;gorisation d & eacute;finitive des risques des interventions en chirurgie plastique et & agrave; une prise en charge p & eacute;riop & eacute;ratoire appropri & eacute;e.
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