Antiplatelet drugs are now used very widely, especially aspirin, which is simply a little bit for those who are sick or not, a little bit for the elderly, a little for high blood pressure, and a little for elderly mothers, not to mention coronary stent surgery or high-risk patients with thromboembolism. However, it is worth exploring how to adjust the medication and balance the risk of bleeding and thrombosis in such patients during non-cardiac surgery. The American College of Chest Physicians (ACCP) recently updated its perioperative antiplatelet guidelines and presented a concise and clear graph, with the following detailed guidelines:
（1）Management of Antiplatelet Drugs Around Minor Procedures (Dental, Dermatologic, Ophthalmologic)，we suggest continuing the antiplateletdrug (ASA or P2Y12 inhibitor) over stopping the antiplatelet agent before the procedure. Patients who are receiving dual antiplatelet therapy with ASA and a P2Y12 inhibitor can continue ASA and interrupt the P2Y12 inhibitor.
(Minor surgeries such as dermatology, ophthalmology, dentistry, etc., such as taking ASA or P2Y12 inhibitors only, can be discontinued, if ASA and P2Y12 are combined, either of them can be discontinued)
（2）In patients receiving ASA who are undergoing elective non-cardiac surgery, we suggest ASA continuation over ASA interruption. In patients receiving ASA therapy who are undergoing elective surgery and require ASA interruption, we suggeststopping ASA ＜7 days instead of 7 to 10 days before the surgery. In patients receiving clopidogrel who are undergoing an elective non-cardiac surgery, we suggest stopping clopidogrel 5 days instead of 7 to 10 days before the surgery, stopping ticagrelor 3 to 5 daysinstead of 7 to 10 days before the surgery, stopping prasugrel 7 days instead of 7 to 10 days before the surgery. In patients who require antiplatelet drug interruption we suggest to resume antiplatelet drugs ＜24 hours instead of > 24 hours after the surgery/procedure.
(It is not recommended to stop aspirin before surgery (except for intracranial surgery, spine surgery), if it must be stopped, it can be stopped for < 7 days, if you are taking Plavix, you only need to stop using it for 5 days, if you are taking Plavix, you only need to stop it for 3-5 days, and if you stop prasugrel for 7 days, you can resume it 24 hours after the end of the surgery)
（3）In patients receiving antiplatelet drug therapy who are undergoing an elective surgery/procedure, we suggest against the routine use of platelet function testing prior to the surgery/procedure to guide perioperative antiplatelet management
(Perioperative platelet function monitoring is not necessary.)
（4）In patients receiving ASA and a P2Y12 inhibitor with coronary stents placed within the last 6 to 12 weeks who are undergoing an elective surgery, we suggest either continuation of both antiplatelet agents or stopping one antiplatelet agent within 7 to 10 days of surgery. within the last 3 to 12 months and are undergoing an elective surgery, we suggest stopping the P2Y12 inhibitor prior to surgery over continuation of the P2Y12 inhibitor
(Patients taking aspirin and P2Y12 inhibitors 6 to 12 weeks after coronary stent implantation are advised to stop taking one of the drugs for 7 to 10 days, or they do not have to stop the drug.) 3 to 12 months after coronary stent implantation, we recommend discontinuing the P2Y12 inhibitor)
（5）In patients with coronary stents who require continued dual antiplatelet therapy, we suggest delaying an elective surgery/procedure over not delaying the surgery/procedure. In patients with coronary stents who require interruption of antiplatelet drugs for an elective surgery, we suggest against routine bridging therapy with a glycoprotein IIb/IIIa inhibitor, cangrelor, or LMWH over routine use of bridging therapy
(Patients undergoing elective surgery who cannot stop taking bispecific antibodies are recommended to postpone surgery.) If surgery is necessary, it is not recommended to use IIb/IIIa receptor antagonists, low molecular weight heparin, etc., and conventional heparin bridging is not recommended.)
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