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Anaesthesia Critical Care & Pain Medicine
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le dimanche 25 novembre 2018
Doi : 10.1016/j.accpm.2018.10.004
Management of antiplatelet therapy for non elective invasive procedures of bleeding complications: proposals from the French working group on perioperative haemostasis (GIHP), in collaboration with the French Society of Anaesthesia and Intensive Care Medicine (SFAR)

A Godier a, , D Garrigue b, D Lasne c, P Fontana d, F Bonhomme e, JP Collet f, E de Maistre g, B Ickx h, Y Gruel i, M Mazighi j, P Nguyen k, A Vincentelli l, P Albaladejo m, T Lecompte d
a Service d'anesthésie-réanimation, AP–HP, hôpital Européen George Pompidou, Paris et INSERM UMRS 1140, Faculté de Pharmacie, Université Paris Descartes, Paris, France 
b CHU de Lille, Pôle d’Anesthésie-Réanimation, CHU Lille, Pôle de l’Urgence, Lille, France 
c Laboratoire central d'hématologie, Hôpital Necker, AP–HP, Paris, France 
d Service d’angiologie et d’hémostase, Département de spécialités de médecine, Hôpitaux Universitaires de Genève, et Geneva Platelet Group, faculté de médecine – Université de Genève, Suisse 
e Département d’anesthésiologie, de pharmacologie et de soins intensifs, Hôpitaux Universitaires de Genève, Suisse 
f Sorbonne Universités Paris 06 (UPMC), ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Département de Cardiologie, Hôpital Pitié-Salpêtrière (AP–HP), Paris, France 
g Service d’Hématologie Biologique – secteur Hémostase, Plateau technique de Biologie, CHU Dijon-Bourgogne, Dijon, France 
h Département d'anesthésie-réanimation, Hôpital Erasme, Bruxelles, Belgique 
i Département d’hématologie-hémostase, Hôpital Universitaire de Tours, Tours, France 
j Département de neuradiologie interventionnelle, Fondation Adolphe de Rothschild, Paris et INSERM U 1148, Hôpital Bichat, Paris, France 
k Service d’hématologie biologique, Pole de biologie du CHU de Reims, France 
l Université de Lille, INSERM U1011-EGID, Lille, France, Institut Pasteur de Lille, Lille, France, CHU Lille, Chirurgie cardiaque, Lille, France 
m Département d'anesthésie-réanimation, et ThEMAS, TIMC, UMR CNRS 5525, Université Grenoble-Alpes, Grenoble, France 

Corresponding author: Service d'anesthésie-réanimation, AP–HP, hôpital Européen George Pompidou, Paris, INSERM UMRS 1140, Faculté de Pharmacie, Université Paris Descartes, Paris, Franceervice d'anesthésie-réanimation, AP–HP, hôpital Européen George Pompidou, Paris, INSERM UMRS 1140, Faculté de Pharmacie, Université Paris DescartesParisFrance

Membres of the Groupe d’intérêt en hémostase périopératoire (GIHP) : P. Albaladejo (Anaesthesia and intensive care, Grenoble, France), S. Belisle (Anaesthesia, Montréal, Canada), N. Blais (Haematology-haemostasis, Montréal, Canada), F. Bonhomme (Anaesthesia and intensive care, Geneva, Switzerland), A. Borel-Derlon (Haematology-haemostasis, Caen, France), JY. Borg (Haemostasis, Rouen, France), J.-L. Bosson (Vascular medicine, Grenoble, France), A. Cohen (Cardiology, Paris, France), J.-P. Collet (Cardiology, Paris, France), E. de Maistre (Haematology, Dijon, France), D. Faraoni (Anaesthesia and intensive care, Toronto, Canada), P. Fontana (Haemostasis, Geneva, Switzerland), D. Garrigue Huet (Anaesthesia and intensive care, Lille, France), A. Godier (Anaesthesia and intensive care, Paris, France), Y. Gruel (Haematology, Tours, France), J. Guay (Anaesthesia, Montréal, Canada), J.F. Hardy (Anaesthesia, Montréal, Canada), Y. Huet (Cardiology, Paris, France), B. Ickx (Anaesthesia and intensive care, Brussels, Belgium), S. Laporte (Pharmacology, Saint-Etienne, France), D. Lasne (Haematology, Paris, France), J.H. Levy (Anaesthesia and intensive care, Durham, USA), J. Llau (Anaesthesia, Valencia, Spain), G. Le Gal (Vascular medicine, Ottawa, Canada), T. Lecompte (Haematology, Geneva, Switzerland), S. Lessire (Anaesthesia, Namur, Belgium), D. Longrois (Anaesthesia and intensive care, Paris, France), S. Madi-Jebara (Anaesthesia, Beirut, Lebanon), E. Marret (Anaesthesia and intensive care, Paris, France), JL. Mas (Neurologie, Paris), M. Mazighi (Neurology, Paris, France), G Meyer (Pneumology, Paris, France), P. Mismetti (Clinical pharmacology, Saint-Etienne, France), P.E. Morange (Haematology, Marseille, France), S. Motte (Vascular pathology, Brussels, Belgium), F. Mullier (Haematology, Namur, Belgium), N. Nathan (Anaesthesia and intensive care, Limoges, France), P. Nguyen (Haematology, Reims, France), Y. Ozier (Anaesthesia and intensive care, Brest, France), G. Pernod (Vascular medicine, Grenoble, France), N. Rosencher (Anaesthesia and intensive care, Paris), S. Roullet (Anaesthesia and intensive care, Bordeaux, France), P.M. Roy (Emergency medicine, Angers, France), C.M. Samama (Anaesthesia and intensive care, Paris, France), S. Schlumberger (Anaesthesia and intensive care, Suresnes, France), J.F. Schved (Haematology, Montpellier, France), P. Sié (Haematology, Toulouse, France), A. Steib (Anaesthesia and intensive care, Strasburg, France), S. Susen (Haematology and transfusion, Lille, France), E. van Belle (Cardiology, Lille, France), P. van Der Linden (Anaetshesia and intensive care, Brussels, Belgium), A. Vincentelli (Heart surgery, Lille, France), et P. Zufferey (Anaesthesia and intensive care, Saint-Étienne, France).


The French Working Group on Perioperative Haemostasis (GIHP) and the French Study Group on Haemostasis and Thrombosis (GFHT) in collaboration with the French Society of Anaesthesia and Intensive Care Medicine (SFAR) drafted up-to-date proposals on the management of antiplatelet therapy for non-elective invasive procedures or bleeding complications. The proposals were discussed and validated by a vote; all proposals could be assigned with a high strength.

Emergency management of oral antiplatelet agents (APA) requires knowledge on their pharmacokinetic/pharmacodynamics parameters, evaluation of the degree of the alteration of haemostatic competence and the associated bleeding risk. Platelet function testing may be considered. When APA-induced bleeding risk may worsen the prognosis, measures should be taken to neutralise antiplatelet therapy by considering not only the efficacy of available means (which can be limited for prasugrel and even more for ticagrelor) but also the risks that these means expose the patient to. The measures include platelet transfusion at the appropriate dose and haemostatic agents (tranexamic acid; rFVIIa for ticagrelor). When possible, postponing non-elective invasive procedures at least for a few hours until the elimination of the active compound (which could compromise the effect of transfused platelets) or if possible a few days (reduction of the effect of APA) should be considered.

The full text of this article is available in PDF format.

Keywords : antiplatelet agents, surgery, invasive procedures, bleeding, thrombosis, platelet transfusion, rFVIIa, tranexamic acid

© 2018  The Authors. Published by Elsevier Masson SAS@@#104157@@
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