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KMID : 0882420220970030150
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Korean Journal of Medicine
2022 Volume.97 No. 3 p.150 ~ p.163
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Consensus Document on Perioperative Antithrombotic Management: Part 1. A Review
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Park Yong-Whi
Her Ae-Young
Kim Hyun-Kuk
Moon Jae-Youn
Park Jae-Hyoung
Park Keun-Ho
Lee Kyoung-Hoon
Joo Hyung-Joon
Won Ho-Youn
Ahn Sung-Gyun
Park Hong-Jun
Hong Sung-Jin
Kim Beom-Joon
Ban Seung-Pil
Suh Jung-Won
Song Young-Bin
Cho Jung-Rae
Jeong Young-Hoon
Kim Weon
Shin Eun-Seok
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Abstract
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The prevalence of ischemic heart disease is steadily growing as populations age. Antithrombotic treatment is a key therapeutic modality for the prevention of secondary cerebro-cardiovascular disease. Patients with acute coronary syndrome or who are undergoing percutaneous coronary intervention must be treated with dual antiplatelet therapy for a mandatory period. The optimal perioperative antithrombotic regimen remains debatable; antithrombotics can cause bleeding. Inadequate antithrombotic regimens are associated with perioperative ischemic events, but continuation of therapy may increase the risks of perioperative hemorrhagic complications (including mortality). Many guidelines on the perioperative management of antithrombotic agents have been established by academic societies. However, the existing guidelines do not cover all specialties, nor do they describe the thrombotic and hemorrhagic risks associated with various surgical interventions. Moreover, few practical recommendations on the modification of antithrombotic regimens in patients who require non-deferrable interventions/surgeries or procedures associated with a high risk of hemorrhage have appeared. Therefore, cardiologists, specialists performing invasive procedures, surgeons, dentists, and anesthesiologists have not come to a consensus on optimal perioperative antithrombotic regimens. The Korean Platelet-Thrombosis Research Group presented a positioning paper on perioperative antithrombotic management. We here discuss commonly encountered clinical scenarios and engage in evidence-based discussion to assist individualized, perioperative antithrombotic management in clinical practice.
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KEYWORD
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Myocardial ischemia, Dual anti-platelet therapy, Anticoagulants, Surgical procedures, operative
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