Management of antiplatelet therapy for non-elective invasive procedures or bleeding complications: Proposals from the French Working Group on Perioperative Haemostasis (GIHP) and the French Study Group on Thrombosis and Haemostasis (GFHT), in collaboratio

Affiliation auteurs!!!! Error affiliation !!!!
TitreManagement of antiplatelet therapy for non-elective invasive procedures or bleeding complications: Proposals from the French Working Group on Perioperative Haemostasis (GIHP) and the French Study Group on Thrombosis and Haemostasis (GFHT), in collaboratio
Type de publicationJournal Article
Year of Publication2019
AuteursGodier A, Garrigue D, Lasne D, Fontana P, Bonhomme F, Collet J-P, De Maistre E, Ickx B, Gruel Y, Mazighi M, Nguyen P, Vincentelli A, Albaladejo P, Lecompte T, Belisle S., Blais N., Borel-Derlon A., Borg J.Y, Bosson J-L, Cohen A., Faraoni D., D. Huet G, Guay J., Hardy J.F, Huet Y., Laporte S., Levy J.H, Llau J., Le Gal G., Lessire S., Longrois D., Madi-Jebara S., Marret E., Mas J.L, Meyer G., Mismetti P., Morange P.E, Motte S., Mullier F., Nathan N., Ozier Y., Pernod G., Rosencher N., Roullet S., Roy P.M, Samama C.M, Schlumberger S., Schved J.F, Sie R., Steib A., Susen S., van Belle E., van Der Linden P., Zufferey P., GIHP
JournalANESTHESIE & REANIMATION
Volume5
Pagination218-237
Date PublishedMAY
Type of ArticleArticle
ISSN2352-5800
Mots-clésantiplatelet agents, bleeding, invasive procedures, Platelet transfusion, rFVIIa, Surgery, thrombosis
Résumé

The French Working Group on Perioperative Haemostasis (GIHP) and the French Study Group on Haemostasis and Thrombosis (GFHT) in collaboration with the French Society of Anaesthesia and Intensive Care Medicine (SFAR) drafted up-to-date proposals on the management of antiplatelet therapy for non-elective invasive procedures or bleeding complications. The proposalswere discussed and validated by a vote; all proposals could be assigned with a high strength. Management of oral antiplatelet agents (APA) in emergency requires knowledge on their pharmacokinetic/pharmacodynamics parameters, evaluation of the degree of the alteration of haemostatic competence and the associated bleeding risk. Platelet function testing maybe considered. When APA-induced bleeding risk mayworsen the prognosis, measures should be taken to neutralise antiplatelet therapy by considering not only the efficacy of available means (which can be limited for prasugrel and even more for ticagrelor) but also the risks that these means expose the patient to. The measures include platelet transfusion at the appropriate dose and haemostatic agents (tranexamic acid; rFVIIa for ticagrelor). When possible, postponing non-elective invasive procedures at least for a few hours until the elimination of the active compound (which could compromise the effect of transfused platelets) or if possible a few days (reduction of the effect of APA) should be considered.
DOI10.1016/j.anrea.2018.10.003