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http://dx.doi.org/10.3904/kjm.2013.85.1.22

Management of Perioperative Antiplatelet Therapy  

Oh, Seok Kyu (Department of Cardiovascular Medicine, Wonkwang University College of Medicine)
Publication Information
The Korean Journal of Medicine / v.85, no.1, 2013 , pp. 22-28 More about this Journal
Abstract
Drug-eluting stent (DES) implatation was the major method of coronary revascularization and marked reduction in target-lesion revascularization. Stent thrombosis (ST) is a severe complication that is associated with a high incidence of acute myocardial infarction and death. To prevent ST, dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is recommended for at least 12 months. The premature discontinuation of DAPT is the single most significant predictor of perioperative ST. The risk of surgical bleeding is increased approximately 20% by aspirin or clopidogrel alone, and 50% by DAPT. But the increased risk of perioperative bleeding is not necessarily associated with increased mortality or surgical outcome. Usually, the risk of a cardiovascular event when stopping antiplatelet agents preoperatively is higher than the risk of surgical bleeding when continuing these drugs, except during high risk surgery in a closed space. We remember that DES are never low risk situation for ST and aspirin must never be stopped in all patients with DES.
Keywords
Drug-eluting stents; Stent thrombosis; Antiplatelet therapy; Perioperative management;
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1 Broad L, Lee T, Conroy M, et al. Successful management of patients with a drug-eluting coronary stent presenting for elective, non-cardiac surgery. Br J Anaesth 2007;98:19-22.   DOI
2 Bigalke B, Seizer P, Geisler T, Lindemann S, Gawaz M, May AE. Perioperative antiplatelet therapy in patients at risk for coronary stent thrombosis undergoing noncardiac surgery. Clin Res Cardiol 2009;98:335-339.   DOI
3 Vicenzi MN, Meislitzer T, Heitzinger B, Halaj M, Fleisher LA, Metzler H. Coronary artery stenting and non-cardiac surgery: a prospective outcome study. Br J Anaesth 2006; 96:686-693.   DOI   ScienceOn
4 Stone GW, Moses JW, Ellis SG, et al. Safety and efficacy of sirolimus- and paclitaxel-eluting coronary stents. N Engl J Med 2007;356:998-1008.   DOI   ScienceOn
5 Daemen J, Wenaweser P, Tsuchida K, et al. Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxeleluting stents in routine clinical practice: data from a large two-institutional cohort study. Lancet 2007;369:667-678.   DOI   ScienceOn
6 Baran KW, Lasala JM, Cox DA, et al. A clinical risk score for prediction of stent thrombosis. Am J Cardiol 2008;102: 541-545.   DOI   ScienceOn
7 Burger W, Chemnitius JM, Kneissl GD, Rücker G. Low-dose aspirin for secondary cardiovascular preventioncardiovascular risks after its perioperative withdrawal versus bleeding risks with its continuation- review and meta-analysis. J Intern Med 2005;257:399-414.   DOI   ScienceOn
8 Newsome LT, Weller RS, Gerancher JC, Kutcher MA, Royster RL. Coronary artery stents: II. Perioperative considerations and management. Anesth Analg 2008;107: 570-590.   DOI   ScienceOn
9 Samama CM, Thiry D, Elalamy I, et al. Perioperative activation of hemostasis in vascular surgery patients. Anesthesiology 2001;94:74-78.   DOI   ScienceOn
10 Sharma AK, Ajani AE, Hamwi SM, et al. Major noncardiac surgery following coronary stenting: when is it safe to operate? Catheter Cardiovasc Interv 2004;63:141-145.   DOI   ScienceOn
11 Abualsaud AO, Eisenberg MJ. Perioperative management of patients with drug-eluting stents. JACC Cardiovasc Interv 2010;3:131-142.   DOI   ScienceOn
12 Schouten O, Bax JJ, Damen J, Poldermans D. Coronary artery stent placement immediately before noncardiac surgery: a potential risk? Anesthesiology 2007;106:1067- 1069.   DOI   ScienceOn
13 Van Kuijk JP, Flu WJ, Schouten O, et al. Timing of noncardiac surgery after coronary artery stenting with bare metal or drug-eluting stents. Am J Cardiol 2009;104: 1229-1234.   DOI   ScienceOn
14 Payne DA, Hayes PD, Jones CI, Belham P, Naylor AR, Goodall AH. Combined therapy with clopidogrel and aspirin significantly increases the bleeding time through a synergistic antiplatelet action. J Vasc Surg 2002;35: 1204-1209.   DOI   ScienceOn
15 Llau JV, Ferrandis R, Sierra P, Gomez-Luque A. Prevention of the renarrowing of coronary arteries using drug-eluting stents in the perioperative period: an update. Vasc Health Risk Manag 2010;6:855-867.
16 Samama CM. Preoperative nonsteroidal antiinflammatory agents as substitutes for aspirin: already too late? Anesthesiology 2007;106:205-206.   DOI   ScienceOn
17 Iakovou I, Schmidt T, Bonizzoni E, et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA 2005;293: 2126-2130.   DOI   ScienceOn
18 Leon MB, Baim DS, Popma JJ, et al. A clinical trial comparing three antithrombotic-drug regimens after coronary-artery stenting: Stent Anticoagulation Restenosis Study Investigators. N Engl J Med 1998;339:1665-1671.   DOI   ScienceOn
19 Eisenstein EL, Anstrom KJ, Kong DF, et al. Clopidogrel use and long-term clinical outcomes after drug-eluting stent implantation. JAMA 2007;297:159-168.   DOI   ScienceOn
20 Park SJ, Park DW, Kim YH, et al. Duration of dual antiplatelet therapy after implantation of drug-eluting stents. N Engl J Med 2010;362:1374-1382.   DOI   ScienceOn
21 Park KW, Lee JM, Kang SH, et al. Safety and efficacy of second-generation everolimus-eluting Xience V stents versus zotarolimus-eluting resolute stents in real-world practice: patient-related and stent-related outcomes from the multicenter prospective EXCELLENT and RESOLUTEKorea registries. J Am Coll Cardiol 2013;61:536-544.   DOI   ScienceOn
22 Nakazawa G, Otsuka F, Nakano M, et al. The pathology of neoatherosclerosis in human coronary implants bare-metal and drug-eluting stents. J Am Coll Cardiol 2011;57:1314-1322.   DOI   ScienceOn
23 Artang R, Dieter R. Analysis of 36 reported cases of late thrombosis in drug-eluting stents placed in coronary arteries. Am J Cardiol 2007;99:1039-1043.   DOI   ScienceOn
24 Chassot PG, Delabays A, Spahn DR. Perioperative antiplatelet therapy: the case for continuing therapy in patients at risk of myocardial infarction. Br J Anaesth 2007; 99:316-328.   DOI   ScienceOn