Drug-eluting stent thrombosis in patients undergoing non-cardiac surgery: is it always a problem?
BACKGROUND
Recent publications have reported high incidence of perioperative complications in patients with drug-eluting stent (DES). The recommendations for bare-metal stents (BMS) are not applicable to DES. In fact, large evidence-based studies are lacking on which to base a consensus for the perioperative management of patients with DES. The aim of the present study is to evaluate the postoperative cardiac risk associated with DES.


METHODS
Prospectively collected data were examined for the rate of postoperative cardiac complications in 96 consecutive patients with DES who underwent digestive, urologic, orthopaedic, or vascular surgery. The average delay between revascularization and non-cardiac surgery was 14 (11) months (extremes 1 week and 36 months). The occurrence of postoperative troponin release (troponin I > or =0.15 ng ml(-1)) and the rate of in-stent thrombosis were analysed.


RESULTS
Twelve patients (12%) presented a postoperative troponin release, without EKG abnormalities in 10 cases (83%). Two patients (2%) developed an in-stent thrombosis. None of the patients had excessive postoperative blood loss.


CONCLUSIONS
Patients with DES are at higher risk of postoperative cardiac complications. Nevertheless, the specific thrombotic complications of the DES were uncommon in this series and this is in contrast to previous alarming reports. A balanced perioperative management of anti-platelet agents, considering both risk for bleeding and risk of thrombotic complications, in patients with DES, is associated with a low risk of thrombosis in the postoperative period. The rate of cardiac complications remains high in these patients due to co-morbidities.
Godet
G
G
Department of Anesthesiology and Critical Care, Centre Hospitalo-Universitaire Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France. gilles.godet@chu-rennes.fr
Le Manach
Y
Y
Lesache
F
F
Perbet
S
S
Coriat
P
P
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D003327:Coronary Disease / Q000628:therapy; D003328:Coronary Thrombosis / Q000209:etiology*; D004334:Drug Administration Schedule; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications; D011184:Postoperative Period; D011446:Prospective Studies; D018570:Risk Assessment; D019210:Troponin I / Q000097:blood
D000925:Anticoagulants; D019210:Troponin I