Perioperative management of patient with intracoronary stent presenting for noncardiac surgery.
Loading...
Date
2016-01
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
As the number of percutaneous coronary interventions increase annually, patients with intracoronary
stents (ICS) who present for noncardiac surgery (NCS) are also on the rise. ICS is associated with stent
thrombosis (STH) and requires mandatory antiplatelet therapy to prevent major adverse cardiac events. The
risks of bleeding and ischemia remain significant and the management of these patients, especially in the
initial year of ICS is challenging. The American College of Cardiologists guidelines on the management of
patients with ICS recommend dual antiplatelet therapy (DAT) for minimal 14 days after balloon angioplasty,
30 days for bare metal stents, and 365 days for drug‑eluting stents. Postponement of elective surgery is
advocated during this period, but guidelines concerning emergency NCS are ambiguous. The risk of STH
and surgical bleeding needs to be assessed carefully and many factors which are implicated in STH, apart
from the type of stent and the duration of DAT, need to be considered when decision to discontinue DAT
is made. DAT management should be a multidisciplinary exercise and bridging therapy with shorter acting
intravenous antiplatelet drugs should be contemplated whenever possible. Well conducted clinical trials are
needed to establish guidelines as regards to the appropriate tests for platelet function monitoring in patients
undergoing NCS while on DAT.
Description
Keywords
Antiplatelet therapy, Coronary stent, Noncardiac surgery
Citation
Gurajala Indira, Gopinath Ramachandran. Perioperative management of patient with intracoronary stent presenting for noncardiac surgery. Annals of Cardiac Anaesthesia. 2016 Jan; 19(1): 122-131.