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JAMA Network Clinical Guideline Synopsis
July 22, 2020

Review of the French Working Group on Perioperative Hemostasis, French Study Group on Thrombosis and Hemostasis, and French Society for Anaesthesia and Intensive Care Guidelines on Management of Antiplatelet Therapy for Nonelective Invasive Procedures or Bleeding Complications

Author Affiliations
  • 1Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 2Division of Acute Care Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 3Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 4Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 5Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland
  • 6Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
JAMA Surg. Published online July 22, 2020. doi:10.1001/jamasurg.2020.2162

Oral antiplatelet therapies (APTs) are a central strategy for managing atherosclerosis and thrombotic disease and are some of the most commonly prescribed medications. Often, patients receiving APTs present with a bleeding event or need for an urgent or nonelective invasive procedure. This commonly prompts an evaluation for the optimal management of APTs, which is complicated because of heterogeneity in the (1) type of APT used, (2) risks of discontinuation, (3) variable effects on different patients taking the same medication and dose, and (4) types, invasiveness, and bleeding risk of surgical procedures. Knowledge of APT pharmacodynamics, the role of platelet function testing, and the indications for, urgency of, and risk of bleeding with a proposed surgery or invasive procedure is necessary to guide these challenging decisions.

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