[The risk of stent thrombosis in the perioperative setting].
Percutaneous coronary interventions associated with a need for long-term dual anti-platelet therapy are steadily increasing. Accordingly, reports of severe perioperative complications in this high-risk group of patients are also increasing. Complications can be categorized into two groups: coronary ischemia or myocardial infarction due to acute stent thrombosis or increased blood loss. Risk of stent thrombosis is higher compared to the risk of bleeding. The article discusses the perioperative management based on an informative case report and recent evidence: Elective surgery has to be postponed until the end of dual anti-platelet therapy. Management of patients planned for semi-elective surgery should be individualized with interdisciplinary consensus. If clopidogrel is withdrawn, aspirin should be administered throughout the perioperative period. Careful surgical technique is required. If surgery is planned within 12 months, implantation of bare metal stents is recommended.
Vicenzi
Martin Norbert
MN
Universitätsklinik für Anästhesiologie und Intensivmedizin, Medizinische Universität Graz, Graz, Austria. martin.vicenzi@medunigraz.at
D015906:Angioplasty, Balloon, Coronary; D003299:Cooperative Behavior; D023903:Coronary Restenosis / Q000175:diagnosis / Q000188:drug therapy*; D003328:Coronary Thrombosis / Q000175:diagnosis / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced; D006801:Humans; D033183:Interdisciplinary Communication; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy*; D009392:Nephrectomy; D010348:Patient Care Team; D019990:Perioperative Care; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy*; D012307:Risk Factors; D015607:Stents
D010975:Platelet Aggregation Inhibitors