Group Issues New Antiplatelet Guideline
With a host of new antiplatelet drugs on the market, the Society of Thoracic Surgeons (STS) has updated its clinical practice guideline on the drugs' use during heart surgery.
Patients at high risk of bleeding should stop taking P2Y12 inhibitors such as clopidogrel (Plavix) and prasugrel  (Effient) for a few days before cardiovascular operations (class I, level of evidence B), according to the statement by Victor A. Ferraris, MD, PhD, from the University of Kentucky in Lexington, and colleagues. The new guidelines also indicate that aspirin discontinuation before purely elective operations in patients without acute coronary syndromes is reasonable to decrease the risk of bleeding.
Prasugrel, a more potent antiplatelet agent than clopidogrel, increases the risk of bleeding following coronary artery bypass grafting (OR 4.7), which must be balanced with its benefits, the STS task force noted in the November 2012 issue of the Annals of Thoracic Surgery.