Prevention of the renarrowing of coronary arteries using drug-eluting stents in the perioperative period: an update.
The management of patients scheduled for surgery with a coronary stent, and receiving 1 or more antiplatelet drugs, has many controversies. The premature discontinuation of antiplatelet drugs substantially increases the risk of stent thrombosis (ST), myocardial infarction, and cardiac death, and surgery under an altered platelet function could also lead to an increased risk of bleeding in the perioperative period. Because of the conflict in the recommendations, this article reviews the current antiplatelet protocols after positioning a coronary stent, the evidence of increased risk of ST associated with the withdrawal of antiplatelet drugs and increased bleeding risk associated with its maintenance, the different perioperative antiplatelet protocols when patients are scheduled for surgery or need an urgent operation, and the therapeutic options if excessive bleeding occurs.
Department of Anaesthesiology and Critical Care Medicine, Hospital Clínic Universitari, València, Spain. juanvllau@gmail.com
Juan V
JV
Llau
Raquel
R
Ferrandis
Pilar
P
Sierra
Aurelio
A
Gómez-Luque
D001241:Aspirin / Q000627:therapeutic use; D016063:Blood Loss, Surgical / Q000517:prevention & control; D000077144:Clopidogrel; D003328:Coronary Thrombosis / Q000517:prevention & control; D003331:Coronary Vessels / Q000187:drug effects / Q000503:physiopathology / Q000601:surgery*; D054855:Drug-Eluting Stents / Q000009:adverse effects; D006801:Humans; D009204:Myocardial Revascularization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D019990:Perioperative Care / Q000379:methods; D059035:Perioperative Period; D010879:Piperazines / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D000068799:Prasugrel Hydrochloride; D013876:Thiophenes / Q000627:therapeutic use; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D013876:Thiophenes; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine; D001241:Aspirin