الفهرس 
Pharmacology of Antiplatelets and Anti-Coagulants
Mechanism of actionOnly 14 pages are availabe for public view
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Abstract
Perioperative management of the risks of
hemorrhage and thrombosis related to gastrointestinal
surgery tailored to patient characteristics are part of daily
multidisciplinary practice tasks. The goal of this work is to
discuss of different types and uses of antiplatelet and
anticoagulant agents and to discuss current practices
concerning antithrombosis prophylaxis and different
challenges in perioperative management of patient on
antiplatelet and anticoagulation therapy undergoing
gastrointestinal surgery.
The duration of prophylaxis is 1 month for
oncological surgery. The recommended doses in bariatric
surgery are twice daily injections of low-molecular weight
heparin without exceeding a total dose of 10,000 IU/day.
Dual antiplatelet therapy is necessary for 6 weeks after
placement of bare-metal stents, from 6—12 months for
drug-eluting stents, and 12 months after an acute coronary
artery syndrome.
Abrupt discontinuation of antiplatelet therapy
exposes the patient to an increased risk of thrombosis.For
major digestive surgery, prescription of daily aspirin should
be discussed case by case. If discontinuation of treatment is
absolutely necessary, this should be as short as possible
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(aspirin: 3 days, ticagrelor and clopidogrel: 5 days,
prasugrel: 7 days).
The modalities for elective management of new oral
anticoagulants are similar to those for classical vitamin K
antagonists (VKA) therapy, except that any overlapping
with heparin administration must be avoided. In the
emergency setting, an algorithm can be proposed
depending on the drug, the available coagulation tests and
the interval before performing surgery.Most operations
performed in gastrointestinal surgery comprise a moderate
to elevated risk of bleeding and/or thrombosis, depending
on the procedure and patient characteristics. Preoperative
evaluation is essential to clearly identify these risks and
adjust the perioperative strategies meant to limit both the
risks of bleeding and onset of venous or arterial thrombosis.
These strategies include thromboprophylaxis and
alsoadministration of long-term treatments (anticoagulants,
antiplatelet agents) to prevent the risk of venous or arterial
thrombosis, so measures should be discussed in a
multidisciplinary fashion to establish consensual protocols
based onthe benefit/risk ratio.