Antiplatelet drugs : is there a surgical risk?

Acetylsalicylic acid has long been the only nonsteroidal anti-inflammatory drug recommended for the treatment and prevention of thromboembolic diseases. More recently, new compounds have been used in patients with vascular diseases. However, these drugs are often associated with longer bleeding times and greater operative risk. In most surgical specialties, the question always arises as to whether antiplatelet therapy should be stopped before elective surgery. If so, for how long? If not, what are the risks? This article reviews the various antiplatelet drugs in use today, focusing on their mode of action, their effects on platelet function and the associated operative risks. It also proposes an algorithm for decision making in this setting, based on the literature and an understanding of the mechanisms of action of this class of drugs.