Disposal of perioperative antiplatelet drugs for patients with nasal endoscopic surgery

  Objective  To explore the rational disposal plan of perioperative antiplatelet drugs for patients with nasal endoscopic surgery.

  Methods  Patients with chronic rhino-sinusitis with or without nasal polyps who underwent endoscopic surgery and had a long-term (more than 1 year) regular administration history of antiplatelet drugs were selected. According to Lund-Mackay (LM) classification of chronic rhino-sinusitis with or without nasal polyps, the patients were divided into category 1 (n=14) and category 2 (n=26). Category 1 was defined as LM score≤12 points, and the patients were randomly divided into group A1 and group B1, with 7 cases in each group. Category 2 was defined as LM score>12 points, and the patients were randomly divided into group A2 and group B2, with 13 cases in each group. Groups A1 and A2 adopted original administration plan of antiplatelet drugs for nasal endoscopic surgery during the perioperative period, while groups B1 and B2 firstly stopped using antiplatelet drugs at 7 days before nasal endoscopic surgery, and then adopted the original plan at 3 days after operation. The operation time, score of intraoperative surgical field bleeding, score of nasal bleeding Visual Analogue Scale (VAS) at 24 hours after operation, rebleeding condition at 7 days after operation and cardiocerebral vascular events at 7 days after operation were compared, and the reasonable methods of disposing antiplatelet drugs were explored.

  Results  The operation time and score of intraoperative surgical field bleeding in the group A2 were significantly higher than those in the group B2 (P < 0.05); the VAS score of nasal bleeding at 24 hours after operation in the group A was significantly higher than that in that group B (P < 0.05); there were no significant differences in rebleeding condition and cardiocerebral vascular events at 7 days after operation between group A and B (P>0.05).

  Conclusion  For patients with chronic rhino-sinusitis with or without nasal polyps with long-term (more than 1 year) administration history of antiplatelet drugs and LM score>12 points in the perioperative period of nasal endoscopic surgery, it is recommended to firstly stop using antiplatelet drugs at 7 days before operation and continue to use antiplatelet drugs at 3 days after surgery, because it has little impact on the nasal endoscopic operation and is conducive to the operation. For patients with chronic rhino-sinusitis with or without nasal polyps with LM score≤12 points, antiplatelet drugs can be used continuously during perioperative period, which has no effect on nasal endoscopic operation.