Discontinuation of perioperative antiplatelet and anticoagulant therapy

Perioperative management of antithrombotic regimens in stroke patients is faced increasingly by physicians. A literature review of perioperative thromboembolic and bleeding risks of antiplatelet agents (AP) or anticoagulants (AC) for stroke prevention suggests that perioperative withdrawal of aspirin increases thromboembolic risk without associated benefits. Many procedures are also safe while continuing AC. Although exact risks associated with temporary cessation of AP and AC are unknown and likely low, morbidity and mortality associated with thromboembolism are high. Physicians must understand the risks and benefits of perioperative AP and AC and when these agents can be safely continued.