User-friendly recommendations on antiplatelet agents: At last, a readable document

Samama, C.M.; Godier, A.

doi:10.1016/j.redare.2018.11.007

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Samama, A. Godier" "autores" => array:2 [ 0 => array:4 [ "nombre" => "C.M." "apellidos" => "Samama" "email" => array:1 [ 0 => "marc.samama@aphp.fr" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Godier" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "AP-HP.5 University Hospitals, Paris, France" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Recomendaciones sencillas sobre el uso de agentes antiplaquetarios: por fin un documento ameno" ] ] "textoCompleto" => "The new Spanish guidelines on the perioperative use of antiplatelet agents (APA) are now available for the readers of the Spanish Journal of Anesthesiology and Critical Care.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> They will represent a very useful tool for perioperative physicians, namely the anaesthetic teams, but many other specialists may take advantage of these recommendations for their daily clinical practice.Nowadays, more and more patients are treated with antiplatelet agents (up to 3% of a standard population in Europe) and the development of interventional cardiology with drug-eluting stent placement has led to longer and stronger treatments with dual antiplatelet therapy (DAPT).<a class="elsevierStyleCrossRef" href="#bib0010">2</a> During the two last decades, new agents have been marketed, namely clopidogrel and then prasugrel, ticagrelor.<a class="elsevierStyleCrossRefs" href="#bib0015">3,4</a> Other compounds are under development. Even aspirin use has increased dramatically.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> All these drugs are associated to a bleeding risk, and their periprocedural management is now part of the curriculum of trainees and fellows in anaesthesiology in developed countries, as it is for CME courses for senior physicians. Therefore, guidelines with regular updates are mandatory to stay connected with the current literature. Better collaborations with neurologists and especially cardiologists are part of the 21st century good clinical practice, and the times are over when the anaesthesiologists were managing these treatments alone. However, even if international guidelines are numerous, and especially North-American and European cardiologic recommendations which are updated every three or four years,<a class="elsevierStyleCrossRef" href="#bib0030">6</a> the published documents are heading to cardiologists and it may be difficult to find immediately applicable recommendations for an emergent procedure. In 2013, the European Society of Anaesthesiology has issued new guidelines on the management of severe bleeding with a section dedicated to APA. An update has been published in 2017.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> They are already much more easy to use. It is reassuring that all these guidelines, including the new Spanish ones, as well as the recent French ones,<a class="elsevierStyleCrossRef" href="#bib0040">8</a> are much more similar in their conclusion than different.The content of the new Spanish guidelines is quite simple to approach as it is presented in a compact and synthetic document. The recommendations appear to be evidenced-based, not eminence-based. The current and past literature has been screened extensively, and it is more than difficult for an expert in the field to identify lacking references. In addition, the vision of these guidelines is not mainstream, but critical, which is not so frequent in the world of Guidelines. No personal expert positions can be found in this document. Obviously, each set of recommendation has been discussed extensively and is justified.Most of the aspects of the periprocedural management of the antiplatelet agents are addressed, including the pharmacology of APA, the indications and the monitoring, the assessment of the induced-bleeding risk, the thrombotic complications when the agents are withdrawn, the indication of bridging and platelet transfusions, and even the use of haemostatic agents. Then, the perioperative management is described, including the anaesthetic risk with the neuraxial procedure and the surgical risk. Some particular conditions are also assessed as urgent surgery. Hopefully, the Spanish Society of Anesthesiology, Resuscitation and Therapeutics of Pain (SEDAR) will develop a smartphone app to help to promote and expand the use of these guidelines.In conclusion, these new Spanish guidelines are an important consensus summarizing many debated questions on the perioperative management of antiplatelet agents. 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ISSN: 2341-1929

Revista Española de Anestesiología y Reanimación (REDAR) -the Spanish Journal of Anesthesiology and Resuscitation- is the scientific body of the Spanish Society of Anesthesiology, Resuscitation and Pain Therapy. This is a monthly journal (10 issues) that publishes scientific articles of all areas within its specialty: clinical anesthesia, resuscitation-intensive medicine and critical care, diagnosis and treatment of acute and chronic pain, urgent care and emergencies and studies on basic science and related fields. The journal accepts work in both Spanish and English.

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Vol. 66. Issue 1.