[Perioperative management of patients with drug-eluting coronary stents presenting for non-cardiac surgery].
After the approval of the drug-eluting coronary stent in Japan in 2004, Japanese cardiologists took the benefit of this new technology to improve the post percutaneus coronary intervention complication of restenosis. Post market studies of drug-eluting coronary stent are becoming available. Unfortunately, many of the results indicate the risk of late stent thrombosis. The chance of stent thrombosis seems elevated when a patient is without antiplatelet medication, dehydrated and in a stressed state. Operation puts the patient in such adverse conditions that might render him to thrombo-producting state. As the use of drug-eluting stent becomes popular, the management of those patients in operative settings becomes inevitable. In this paper, we reviewed the medical records of 20 patients for surgery with drug-eluting coronary stents in our hospital. Time intervals between stent placement and surgery were: less than 90 days (2 cases), less than 180 days (3 cases), less than one year (8 cases), more than one year (7 cases). There was no stent thrombosis in the perioperative period. We did not take precautionary steps for stent thrombosis in the perioperative period, except in two cases where operations were performed recently (One patients received heparin and the other patients received aspirin and cilostazol). None of patients had excessive blood loss. However, many reports suggest the increasing risk of stent thrombosis in patients with the drug-eluting coronary stents presenting for non-cardiac surgery. They also suggest that, in contrast to bare metal stent, there may be no association between the risk of stent thrombosis and time intervals from stent placement to surgery. We should pay more attention to management of patients with drug-eluting coronary stents presenting for non-cardiac surgery.
Arai
Fumio
F
Department of Anesthesiology, Osaka Police Hospital, Osaka 543-0035.
Kita
Takashi
T
Sasaki
Shigeta
S
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D001241:Aspirin / Q000008:administration & dosage; D000077407:Cilostazol; D004334:Drug Administration Schedule; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D013777:Tetrazoles / Q000008:administration & dosage; D013927:Thrombosis / Q000209:etiology* / Q000517:prevention & control*; D013988:Ticlopidine / Q000008:administration & dosage; D013997:Time Factors
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D006493:Heparin; D000077407:Cilostazol; D013988:Ticlopidine; D001241:Aspirin