[Management of a high risk of thrombosis patient with drug-eluting stents undergoing a complete gastrectomy].
We report the case of a 70-year-old patient, with two drug-eluting stents (DES), scheduled for a complete gastrectomy for a gastric cancer. This case underlines management problems regarding a patient with a high risk of DES thrombosis in case of AAP withdrawal and a high risk of bleeding in case of AAP maintenance. At this time, no evidence-based recommendation is available for clinicians to manage these patients. Our strategy was therefore based on platelet function monitoring test, which is however neither available in clinical practice nor validated to predict haemorrhagic risk. Several biologic tests are under study; they could be useful to guide perioperative management of antiplatelet therapy in the clinical setting of surgical patients with DES.
Demaret
C
C
ERI 022, service d'anesthésie-réanimation, université Claude-Bernard Lyon 1, CHU Lyon-Sud, 69495 Pierre-Bénite cedex, France.
Crousier
M
M
Hanss
M
M
Ffrench
P
P
Piriou
V
V
D000368:Aged; D000077144:Clopidogrel; D054855:Drug-Eluting Stents; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic; D010974:Platelet Aggregation / Q000187:drug effects / Q000502:physiology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D010979:Platelet Function Tests; D011183:Postoperative Complications / Q000517:prevention & control*; D013274:Stomach Neoplasms / Q000601:surgery; D013927:Thrombosis / Q000517:prevention & control*; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine