Double jeopardy: balance between bleeding and stent thrombosis with prolonged dual antiplatelet therapy after drug-eluting stent implantation.
Prolonged dual antiplatelet therapy with aspirin and clopidogrel is mandatory after drug-eluting stent (DES) implantation because of potential increase risk of stent thrombosis compared to bare-metal stents. As more DES are being implanted, many of these patients will undergo non-cardiac surgery whilst on antiplatelet therapy. The optimal management of perioperative antiplatelet therapy is not well established. The risk of excessive bleeding associated with antiplatelet therapy needs to be balanced against the risk of stent thrombosis with interruption of antiplatelet therapy on a case-to-case basis.
Yan
Bryan P
BP
Department of Cardiology, Royal Melbourne Hospital, Melbourne 3050, Australia.
Gurvitch
Ronen
R
Ajani
Andrew E
AE
D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use; D019917:Blood Vessel Prosthesis Implantation; D002986:Clinical Trials as Topic; D000077144:Clopidogrel; D020099:Coated Materials, Biocompatible / Q000627:therapeutic use*; D003327:Coronary Disease / Q000601:surgery; D006083:Graft Occlusion, Vascular / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D013997:Time Factors
D020099:Coated Materials, Biocompatible; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin