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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 collaboration with the French Society for Anaesthesia and Intensive Care (SFAR).

Authors
  • Godier, Anne1
  • Garrigue, Dephine2
  • Lasne, Dominique3
  • Fontana, Pierre4
  • Bonhomme, Fanny5
  • Collet, Jean-Philippe6
  • de Maistre, Emmanuel7
  • Ickx, Brigitte8
  • Gruel, Yves9
  • Mazighi, Mikael10
  • Nguyen, Philippe11
  • Vincentelli, André12
  • Albaladejo, Pierre13
  • Lecompte, Thomas4
  • 1 Département d'anesthésie-réanimation, fondation Adolphe-de-Rothschild, 75019 Paris, France; Inserm UMRS 1140, faculté de pharmacie, université Paris-Descartes, 75270 Paris, France. Electronic address: [email protected] , (France)
  • 2 Pôle d'anesthésie-réanimation, CHU de Lille, 59037 Lille, France; Pôle de l'urgence, CHU de Lille, 59037 Lille, France. , (France)
  • 3 Laboratoire central d'hématologie, hôpital Necker, AP-HP, 75015 Paris, France. , (France)
  • 4 Service d'angiologie et d'hémostase, département de spécialités de médecine, hôpitaux universitaires de Genève, 1205 Genève, Switzerland; Geneva Platelet Group, faculté de médecine, université de Genève, 1205 Genève, Switzerland. , (Switzerland)
  • 5 Département d'anesthésiologie, de pharmacologie et de soins intensifs, hôpitaux universitaires de Genève, 1211 Genève, Switzerland. , (Switzerland)
  • 6 Inserm UMRS 1166, département de cardiologie, institut de cardiologie, hôpital Pitié-Salpêtrière, Sorbonne universités Paris 06 (UPMC), ACTION Study Group, AP-HP, 75013 Paris, France. , (France)
  • 7 Service d'hématologie biologique - secteur hémostase, plateau technique de biologie, CHU Dijon-Bourgogne, 21000 Dijon, France. , (France)
  • 8 Département d'anesthésie-réanimation, hôpital Erasme, 1070 Bruxelles, Belgium. , (Belgium)
  • 9 Département d'hématologie-hémostase, hôpital universitaire de Tours, 37170 Tours, France. , (France)
  • 10 Département de neuradiologie interventionnelle, fondation Adolphe-de-Rothschild, 75019 Paris, France; Inserm U 1148, hôpital Bichat, 75877 Paris, France. , (France)
  • 11 Service d'hématologie biologique, pôle de biologie, CHU de Reims, 51092 Reims, France. , (France)
  • 12 Inserm U1011-EGID, University of Lille, 59019 Lille, France; Institut Pasteur de Lille, 59000 Lille, France; Cardiac Surgery, CHU de Lille, 59000 Lille, France. , (France)
  • 13 Département d'anesthésie-réanimation, CHU Grenoble-Alpes, 38043 Grenoble, France; ThEMAS, TIMC, UMR CNRS 5525, université Grenoble-Alpes, 38041 Grenoble, France. , (France)
Type
Published Article
Journal
Archives of cardiovascular diseases
Publication Date
Mar 01, 2019
Volume
112
Issue
3
Pages
199–216
Identifiers
DOI: 10.1016/j.acvd.2018.10.004
PMID: 30621917
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The French Working Group on Perioperative Haemostasis (GIHP) and the French Study Group on Haemostasis and Thrombosis (GFHT), in collaboration with the French Society for Anaesthesia and Intensive Care (SFAR), drafted up-to-date proposals on the management of antiplatelet therapy for non-elective invasive procedures or bleeding complications. The proposals were discussed and validated by a vote; all proposals could be assigned with a high strength. Management of oral antiplatelet agents in emergency settings requires knowledge of their pharmacokinetic and pharmacodynamic parameters, evaluation of the degree of alteration of haemostatic competence and the associated bleeding risk. Platelet function testing may be considered. When antiplatelet agent-induced bleeding risk may worsen the prognosis, measures should be taken to neutralize 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; recombinant activated factor VII 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, for a few days (reduction of the effect of antiplatelet agents) should be considered. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

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