A tale of two stents: perioperative management of patients with drug-eluting coronary stents.
Drug-eluting stents were introduced into clinical practice to decrease coronary stent restenosis rates. Though remarkably effective in reducing this complication, recent data reveal that drug-eluting stents pose a significant risk for late stent thrombosis, an event strongly correlated with discontinuation of anti-platelet therapy. Because anti-platelet agents are often discontinued perioperatively, patients with DES are at risk for perioperative stent thrombosis and myocardial infarction. Along with a review of the recent literature, we present two cases of patients with drug-eluting stents scheduled for renal transplantation. Two distinct antithrombotic management strategies illustrate the risk of either approach-bleeding and transfusion versus stent thrombosis and myocardial infarction.
Head
Diane E
DE
Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA. dehead@wisc.edu
Sebranek
Joshua J
JJ
Zahed
Cameron
C
Coursin
Douglas B
DB
Prielipp
Richard C
RC
D000465:Algorithms; D023921:Coronary Stenosis / Q000209:etiology / Q000517:prevention & control*; D003328:Coronary Thrombosis / Q000188:drug therapy / Q000209:etiology*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D019106:Postoperative Hemorrhage / Q000139:chemically induced*; D013997:Time Factors