Ricerca avanzata

Home > Riviste > International Angiology > Fascicoli precedenti > International Angiology 2010 Dicembre;29(6) > International Angiology 2010 Dicembre;29(6):475-81



Rivista di Angiologia

Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 0,899

Periodicità: Bimestrale

ISSN 0392-9590

Online ISSN 1827-1839


International Angiology 2010 Dicembre;29(6):475-81


Preoperative withdrawal of antiplatelet treatment in lower limb vascular patients prior to surgical management under epidural or spinal anaesthesia: an evidence based approach and systematic review

Kotsovolis G., Komninos G., Kyrgidis A., Papadimitriou D.

Postgraduate Education in Medical Research Methodology, School of Medicine, Aristotelian University of Thessaloniki, Greece

Antiplatelet drugs given to high risk patients for secondary prevention of cardiovascular disease are frequently withdrawn prior to surgical or diagnostic procedures to reduce bleeding complications. This is also the case for many patients undergoing lower limb vascular surgery via spinal or epidural anaesthesia. The aim of this study is to corroborate the clinician’s decision for discontinuing or continuing the anti-platelet treatment in these patients perioperatively. We screened MEDLINE and Scopus (January 1980 – July 2007) with additional manual cross-referencing for clinical studies, surveys on the opinions of doctors and guidelines according to Evidence Based Medicine rules. One randomized controlled trial, 2 meta-analyses, 1 prospective and 4 retrospective studies as well as 6 esteemed medical societies’” guidelines all conclude that there is no justification for the discontinuation of aspirin and NSAIDs prior to neuraxial anesthesia. However, for other antiplatelet drugs like ticlopidine, clopidogrel, abciximab, eptifabatide and tirofiban not enough data exist to support their continuation through the procedure. Therefore, their preoperative withdrawal is suggested 8 hours to 14 days prior, accordingly. The existing evidence does not justify the discontinuation of aspirin and NSAIDs before the intended procedure. Anesthesiologists and surgeons should be aware of the cardiovascular risks of withdrawal versus the non – evidence based benefit in hemorrhage complications.

lingua: Inglese


inizio pagina