Perioperative Management of Antiplatelet Agents by Anesthesiologists and Cardiologists

Antiplatelet agents (APAs) are essential in the management of atheromatous disease. The number of patients on long-term antiplatelet therapy who require scheduled invasive procedures is increasing each year. Managing antiplatelet therapy in the perioperative period remains a significant challenge for both cardiologists and anesthesiologists. Achieving a balance between the hemorrhagic risk associated with surgery and the thrombotic risk from modifying antiplatelet therapy is crucial. Our study compared the perioperative management of antiplatelet agents among 50 anesthesiology and intensive care residents and 43 cardiology residents at our university hospital, referencing European and American guidelines. The results indicate that cardiology residents tend to prioritize the thrombotic risk, minimizing the discontinuation period of antiplatelet agents. In contrast, anesthesiology residents are more cautious regarding hemorrhagic risk, especially in the management of anti-P2Y12 monotherapy and dual antiplatelet therapy, often opting for longer discontinuation periods. In line with our findings and the literature, both specialties strive to balance thrombotic and hemorrhagic risks, though cardiologists may focus more on thrombotic complications, while anesthesiologists emphasize bleeding risk. The therapeutic approach is inherently multidisciplinary and should be individualized based on patient-specific and procedural risks, as endorsed by current guidelines.