[Perioperative discontinuation of antiplatelet therapy of patients with coronary stents. Reevaluating the risks].
According to the present guidelines, patients with coronary stents are to be treated with dual antiplatelet therapy. In case surgery is needed, the risk of a fatal stent thrombosis by withdrawing antithrombotics needs to be balanced in each individual case against the risk of haemorrhagic complications on continued antiplatelet medication. We present a case of fatal stent thrombosis and discuss the current evidence regarding perioperative continuation and interruption of antiplatelet therapy for this patient population. In summary the haemorrhagic risk with acetylsalicylic acid for secondary prevention seems very low, and it should be discontinued only in selected cases. Continued dual anticoagulation concepts are also discussed.
Graw
J
J
Universitätsklinik für Anästhesiologie und Operative Intensivmedizin, Campus Virchow Klinikum und Campus Mitte, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
Schwenk
W
W
Volk
T
T
D000465:Algorithms; D015906:Angioplasty, Balloon, Coronary; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects*; D000077144:Clopidogrel; D023903:Coronary Restenosis / Q000139:chemically induced*; D003663:Decision Trees; D054855:Drug-Eluting Stents; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D007431:Intraoperative Complications / Q000139:chemically induced*; D008134:Long-Term Care; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects*; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors; D013375:Substance Withdrawal Syndrome / Q000209:etiology*; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin