title: Discontinuation of antiplatelet therapy prior to low-risk noncardiac surgery in patients with drug-eluting stents: a retrospective cohort study.
abstract: BACKGROUND
  Drug-eluting coronary stents (DESs) pose a challenge in the perioperative period. Sirolimus and paclitaxel may inhibit reendothelialization of the traumatized vessel, making it vulnerable to platelet-mediated thrombosis. Given the anecdotal evidence and case series suggesting that DESs may be more vulnerable to thrombosis on discontinuation of antiplatelet agents than are bare-metal stents, we sought to quantify this risk.
  
  
  METHODS
  We linked the Cleveland Clinic Heart Center database with the Cleveland Clinic Internal Medicine Preoperative Assessment Consultation and Treatment (IMPACT) Center database to identify all patients who had undergone DES placement at the Cleveland Clinic and subsequently were evaluated for noncardiac surgery between July 2003 and July 2005. Outcome measures included 30-day rate of postoperative myocardial infarction (MI), DES thrombosis, major bleeding, and all-cause mortality.
  
  
  RESULTS
  We identified 114 patients who underwent noncardiac surgery a median of 236 days (IQR 125-354) after stent placement. Forty-five patients (40%) underwent surgery within 180 days of stenting, 15 of whom (13%) underwent surgery within 90 days of stenting. Eighty-eight patients (77%) discontinued all antiplatelet agents a median of 10 days before surgery. No patients died. Two patients (1.8%, 95% CI 0.5%-6.2%) suffered postoperative MIs, but postoperative catheterization showed neither had DES thrombosis (0%, 95% CI 0%-3.3%). One patient developed major bleeding (0.9%, CI 0.2%-4.8%).
  
  
  CONCLUSIONS
  These data suggest that the overall risk of stent thrombosis is low in low-risk noncardiac surgery patients with DESs, particularly those who have undergone at least 180 days of antiplatelet therapy, even after complete discontinuation of antiplatelet agents.
authors: Hospitalist Program, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors: Daniel J
authors: DJ
authors: Brotman
authors: Mihir
authors: M
authors: Bakhru
authors: Wael
authors: W
authors: Saber
authors: Ashish
authors: A
authors: Aneja
authors: Deepak L
authors: DL
authors: Bhatt
authors: Katherina
authors: K
authors: Tillan-Martinez
authors: Amir K
authors: AK
authors: Jaffer
mesh_terms: D000368:Aged; D015331:Cohort Studies; D054855:Drug-Eluting Stents / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011300:Preoperative Care / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D010975:Platelet Aggregation Inhibitors