Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
Issue link: http://outpatientsurgery.uberflip.com/i/329643
SAFETY 1 5 4 O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | J U N E 2 0 1 4 balance between minimizing bleeding risks and minimizing the risk of a cardiac event. Many factors have to be taken into account, including the overall health of the patient, and weighing bleeding risks against the risk of the patient suffering a clot, and the likelihood of the clot being cata- strophic when it forms. If the surgery is elective, it's best to wait until the patient has been on dual antiplatelet therapy for at least 12 months. Once the patient has been stable for more than a year, the cardiologist may temporarily discontinue the antiplatelet agent and keep them on aspirin while they undergo surgery and during the very early stages of recovery. For more than 15 years, clopidogrel (Plavix) has been one of the most widely used antiplatelet agents for patients with high-risk cardio- vascular disease. In the early part of the last decade, my research team was the first to show that up to 30% of patients taking clopido- grel do not effectively respond to the drug. While our findings sparked a heated debate in the cardiology community and exposed that those not responding to the drug were at increased risk for a cardiac event (often unknowingly), it also implied that clopidogrel non-responders would not be at increased risk for bleeding during surgery, since they were not receiving the drug's anti-thrombotic benefits. If patients are on clopidogrel, but prove to be resistant, they may be able to have surgery within 24 hours of the last dose, which has a neg- ligible effect in about one-third of patients who take it. If you follow conventional cardiology guideline recommendations, you'd keep patients waiting for 5 days until the drug clears their systems. Surgery guidelines are a bit more progressive in attempting to keep patients from waiting, if they don't have pharmacodynamics effects from the drug. Our research is paving the way for a more personalized approach to OS_1406_part3_Layout 1 6/13/14 11:56 AM Page 154