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Management of Antiplatelet Therapy in Patients at Risk for Coronary Stent Thrombosis Undergoing Non-Cardiac Surgery

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Abstract

Percutaneous coronary interventions (PCIs) have become the most commonly performed coronary revascularization procedures. At the same time, there is an increased likelihood that patients with intracoronary stents will need to undergo surgery. Two serious consequences emerge from this situation: (i) stent thrombosis in relation to discontinuation of antiplatelet therapy, and (ii) major bleeding in relation to continuation of antiplatelet therapy. The best solution to overcome the risks resulting from surgery performed in patients after stent implantation is to postpone the operation until after re-endothelialization of the vessel surface is completed. Expert recommendations advise that patients can be sent for non-cardiac surgery 3 months after bare-metal stent PCI and 12 months after drug-eluting stent PCI, with continuation of aspirin therapy. Difficult decisions regarding antiplatelet management arise when a patient that is still receiving dual antiplatelet therapy with aspirin and a thienopyridine has to undergo surgery that cannot be postponed. Discussions between the treating cardiologist, the surgeon and the anaesthesiologist about this situation are recommended in order to achieve a reasonable expert consensus.

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Acknowledgements

This article was supported by the Internal Grant Agency of the Ministry of Health, Czech Republic, Project No. NT11506. The author has no financial or personal relationships that could inappropriately influence (or bias) the author’s decisions, work or manuscript.

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  1. 3rd Medical Faculty of Charles University, Cardiocentre University Hospital Vinohrady, Srobarova 50, 100, 34 Prague 10, Czech Republic

    Zuzana Motovska MD, PhD, FESC

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Correspondence to Zuzana Motovska MD, PhD, FESC.

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Motovska, Z. Management of Antiplatelet Therapy in Patients at Risk for Coronary Stent Thrombosis Undergoing Non-Cardiac Surgery. Drugs 71, 1797–1806 (2011). https://doi.org/10.2165/11594260-000000000-00000

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