Editing Antiplatelet drug (section)

== Management in the perioperative period ==
Antiplatelet therapy may increase the risk of a bleed during surgery, however, stopping therapy may increase the risk of other thrombotic problems including myocardial infarction.<ref name=":1">{{cite journal | vauthors = Lewis SR, Pritchard MW, Schofield-Robinson OJ, Alderson P, Smith AF | title = Continuation versus discontinuation of antiplatelet therapy for bleeding and ischaemic events in adults undergoing non-cardiac surgery | journal = The Cochrane Database of Systematic Reviews | volume = 7 | issue = 7 | pages = CD012584 | date = July 2018 | pmid = 30019463 | pmc = 6513221 | doi = 10.1002/14651858.CD012584.pub2 }}</ref> When considering these medications and the risk-benefit ratio in the perioperative period, one must consider the risk of stopping the medication and a clot forming versus the risk of bleeding during or after the surgery if medication is continued.<ref>{{cite journal | vauthors = Yeung LY, Sarani B, Weinberg JA, McBeth PB, May AK | title = Surgeon's guide to anticoagulant and antiplatelet medications part two: antiplatelet agents and perioperative management of long-term anticoagulation | journal = Trauma Surgery & Acute Care Open | volume = 1 | issue = 1 | pages = e000022 | date = 2016 | pmid = 29767644 | pmc = 5891708 | doi = 10.1136/tsaco-2016-000022 }}</ref> A 2018 Cochrane Review that included five randomized controlled trials found low-certainty evidence to suggest that continuing or discontinuing antiplatelet therapy for a non-cardiac surgery does not make a difference in mortality, major bleeds that require surgery, or ischaemic events.<ref name=":1" /> The same review found moderate certainty evidence that continuing or discontinuing therapy also did not have a big difference on the incidence of bleeds requiring a blood transfusion.<ref name=":1" />

* Balloon angioplasty in the preoperative period – patients can proceed to surgery two weeks after the procedure.
* Bare metal stents required at least one month of DAPT
* CABG: Patients may proceed with surgery as soon as they are healed from the coronary artery bypass procedure and they do not need any specific amount of time on DAPT
* In patients with truly time-sensitive disease (defined in the 2014 ACC/AHA guidelines as needing to proceed in 2–6 weeks), DAPT can be stopped 3 (three) months (90 days) after a coronary stent is placed if postponing surgery any longer would result in significant morbidity. Examples of these types of surgeries include some cancer surgery and possibly some orthopedic surgery (non-urgent/emergent fracture management). Preferably 6 to 12 months of DAPT should be continued in patients having elective surgery.