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Editorial article
User-friendly recommendations on antiplatelet agents: At last, a readable document
Recomendaciones sencillas sobre el uso de agentes antiplaquetarios: por fin un documento ameno
C.M. Samama
Corresponding author
marc.samama@aphp.fr

Corresponding author.
, A. Godier
AP-HP.5 University Hospitals, Paris, France
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The new Spanish guidelines on the perioperative use of antiplatelet agents &#40;APA&#41; are now available for the readers of the Spanish Journal of Anesthesiology and Critical Care&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> They will represent a very useful tool for perioperative physicians&#44; namely the anaesthetic teams&#44; but many other specialists may take advantage of these recommendations for their daily clinical practice&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Nowadays&#44; more and more patients are treated with antiplatelet agents &#40;up to 3&#37; of a standard population in Europe&#41; and the development of interventional cardiology with drug-eluting stent placement has led to longer and stronger treatments with dual antiplatelet therapy &#40;DAPT&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> During the two last decades&#44; new agents have been marketed&#44; namely clopidogrel and then prasugrel&#44; ticagrelor&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> Other compounds are under development&#46; Even aspirin use has increased dramatically&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> All these drugs are associated to a bleeding risk&#44; and their periprocedural management is now part of the curriculum of trainees and fellows in anaesthesiology in developed countries&#44; as it is for CME courses for senior physicians&#46; Therefore&#44; guidelines with regular updates are mandatory to stay connected with the current literature&#46; Better collaborations with neurologists and especially cardiologists are part of the 21st century good clinical practice&#44; and the times are over when the anaesthesiologists were managing these treatments alone&#46; However&#44; even if international guidelines are numerous&#44; and especially North-American and European cardiologic recommendations which are updated every three or four years&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> the published documents are heading to cardiologists and it may be difficult to find immediately applicable recommendations for an emergent procedure&#46; In 2013&#44; the European Society of Anaesthesiology has issued new guidelines on the management of severe bleeding with a section dedicated to APA&#46; An update has been published in 2017&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> They are already much more easy to use&#46; It is reassuring that all these guidelines&#44; including the new Spanish ones&#44; as well as the recent French ones&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> are much more similar in their conclusion than different&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The content of the new Spanish guidelines is quite simple to approach as it is presented in a compact and synthetic document&#46; The recommendations appear to be evidenced-based&#44; not eminence-based&#46; The current and past literature has been screened extensively&#44; and it is more than difficult for an expert in the field to identify lacking references&#46; In addition&#44; the vision of these guidelines is not mainstream&#44; but critical&#44; which is not so frequent in the world of Guidelines&#46; No personal expert positions can be found in this document&#46; Obviously&#44; each set of recommendation has been discussed extensively and is justified&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Most of the aspects of the periprocedural management of the antiplatelet agents are addressed&#44; including the pharmacology of APA&#44; the indications and the monitoring&#44; the assessment of the induced-bleeding risk&#44; the thrombotic complications when the agents are withdrawn&#44; the indication of bridging and platelet transfusions&#44; and even the use of haemostatic agents&#46; Then&#44; the perioperative management is described&#44; including the anaesthetic risk with the neuraxial procedure and the surgical risk&#46; Some particular conditions are also assessed as urgent surgery&#46; Hopefully&#44; the Spanish Society of Anesthesiology&#44; Resuscitation and Therapeutics of Pain &#40;SEDAR&#41; will develop a smartphone app to help to promote and expand the use of these guidelines&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion&#44; these new Spanish guidelines are an important consensus summarizing many debated questions on the perioperative management of antiplatelet agents&#46; Clinicians are encouraged to consult this user-friendly document&#44; awaiting the results of future studies that will perhaps slightly modify it&#46;</p></span>"
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ISSN: 23411929
Original language: English
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