Perioperative antithrombotic (antiplatelet and anticoagulant) therapy in urological practice: a critical assessment and
- PDF / 576,173 Bytes
- 10 Pages / 595.276 x 790.866 pts Page_size
- 87 Downloads / 171 Views
INVITED REVIEW
Perioperative antithrombotic (antiplatelet and anticoagulant) therapy in urological practice: a critical assessment and summary of the clinical practice guidelines Konstantinos Dimitropoulos1 · Muhammad Imran Omar1 · Athanasios Chalkias2 · Eleni Arnaoutoglou2 · James Douketis3 · Stavros Gravas4 Received: 11 November 2019 / Accepted: 2 January 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The perioperative management of patients who are receiving antithrombotic (antiplatelet or anticoagulant) therapy and require urologic surgery is challenging due to the inherent risk for surgical bleeding and the need to minimize thromboembolic risk. The aim of this review is to assess the quality and consistency of clinical practice guidelines (CPGs) and clinical practice recommendations (CPRs) on this topic, and to summarize the evidence and associated strength of recommendations relating to perioperative antithrombotic management. Methods A pragmatic search of electronic databases and guidelines websites was performed to identify relevant CPGs/CPRs. The AGREE II (Appraisal of Guidelines for REsearch and Evaluation) instrument was used to assess the methodological quality and integrity of the CPGs. Results The CPGs provided by the European Association of Urology (EAU), the American College of Chest Physicians (ACCP) and the European Society of Cardiology/European Society of Anaesthesiology (ESC/ESA), and the CPRs provided by the International Consultation on Urological Disease (ICUD)/American Urologic Association (AUA) were retrieved and reviewed. The 3 CPGs were critically assessed using the AGREE II instrument. Inconsistent recommendations were provided based on the indication for antithrombotic medication, the antiplatelet/anticoagulant agent and the type of urological procedure. Based on the AGREE II tool for CPG assessment, the EAU CPGs scored higher (83.3 points) compared to the ESC/ESA (75 points) and ACCP CPG (66.7 points). Conclusion The perioperative management of antithrombotic therapy in urological patients is potentially challenging but inconsistent CPG of varying quality may create uncertainty as to best practices to minimize thromboembolic and bleeding risk. Keywords Antiplatelet · Anticoagulant · Antithrombotic · Urology · Urological · Perioperative · Surgery · Guidelines
Introduction
* Konstantinos Dimitropoulos [email protected] 1
Academic Urology Unit, University of Aberdeen, Aberdeen, Scotland, UK
2
Department of Anaesthesiology, University Hospital of Larissa, Larissa, Greece
3
Department of Medicine, McMaster University, Hamilton, ON, Canada
4
Department of Urology, University Hospital of Larissa, Larissa, Greece
Acute or elective management of patients on antithrombotic (antiplatelet or anticoagulant) therapy presents a challenge for surgeons because of the intrinsic risk for intra- and postoperative bleeding associated with most urologic surgery and the need to minimize thromboembolic risk. With an aging population, an increa
Data Loading...
