Leczenie przeciwpłytkowe w okresie okołooperacyjnym

*Piotr Nowakowski¹, Dariusz Kosson^{1, 2, 3}, Ewa Mayzner-Zawadzka¹

Summary
Antiplatelet treatment has become a standard primary and secondary prophylaxis regimen in cardiology. Antiplatelet therapy protects against vascular events in patients with stable angina, intermittent claudication, and atrial fibrillation. Its primary target is arterial thrombosis. Venous thrombosis is well prevented by low molecular weight heparins. Prophylaxis for arterial thrombosis concentrates on prevention of platelet aggregation, initiated by atherosclerotic damage to vascular epithelium. For long-term antiplatelet therapy, the main drugs are aspirin and the thienopyridines. They decrease the incidence of serious thrombotic events, like myocardial and cerebral infarction, by 25%.
The authors review platelet pathophysiology, and mechanisms of action and clinical efficacy of antiplatelet drugs, mainly aspirin, ticlopidine and clopidogrel. The rationale for use of antiplatelet drugs and perioperative risks are discussed. The absolute benefits of such therapy substantially outweigh the absolute risks of major bleeding associated with surgery, therefore interruption of this therapy in the perioperative period should be considered on an individual basis. The use of antiplatelet drugs should not be considered as an absolute contraindication for neuraxial blocks, except when a patient receives a combination of different drugs.

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