[Drug-eluting stents: implications for surgery patients].
Percutaneous coronary intervention (PCI) has a special role in the treatment of coronary heart disease. The insertion of drug-eluting stents (DES) requires dual anti-platelet therapy for at least 1 year which makes planned and emergency surgery difficult. There is a dilemma between high risk of stent thrombosis and perioperative bleeding. There is no evidence-based, bridging therapy option available perioperatively. This complex of problems should be considered whenever PCI is performed. An interdisciplinary approach is obligatory in these imminent conditions to proceed with either interventional or surgical revascularization. Co-existing malignancies and disorders which must be treated surgically should be excluded before PCI. Furthermore, DES and dual anti-platelet therapy produce unanswered forensic questions. On legal grounds it is not possible to proceed with surgery in cases of medication with anti-platelet therapy. Therefore, it is mandatory to discuss the possible answers to this problem with health care lawyers. The patient must be informed about this complex of problems.
Klinik für Thoraxchirurgie, Dr.-Horst-Schmidt-Kliniken, Ludwig-Erhard-Strasse 100, 65199 Wiesbaden, Deutschland.
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D000465:Algorithms; D015906:Angioplasty, Balloon, Coronary; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects*; D000077144:Clopidogrel; D003299:Cooperative Behavior; D023903:Coronary Restenosis / Q000139:chemically induced* / Q000517:prevention & control; D003663:Decision Trees; D054855:Drug-Eluting Stents; D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D006470:Hemorrhage / Q000139:chemically induced* / Q000517:prevention & control; D006801:Humans; D033183:Interdisciplinary Communication; D007431:Intraoperative Complications / Q000139:chemically induced* / Q000517:prevention & control; D008134:Long-Term Care; D010348:Patient Care Team; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects*; D018570:Risk Assessment; D013375:Substance Withdrawal Syndrome / Q000209:etiology* / Q000517:prevention & control; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin