title: Focused clinical review: periprocedural management of antiplatelet therapy in patients with coronary stents.
abstract: Coronary stent implantation, particularly drug eluting stents, is now the major method of coronary revascularisation. Following drug-eluting stent implantation dual antiplatelet therapy with aspirin and thienopyridine is recommended for at least 12 months. Premature discontinuation, often at the time of noncardiac surgery, has been associated with stent thrombosis which has a significant risk of death and myocardial infarction. Late (>30 days) and very late (>365 days) stent thrombosis appears to more common with DES and poses the questions of when is it safe to stop antiplatelet therapy post coronary stenting and how to manage patients who need non-cardiac surgery. This article reviews the evidence for stent thrombosis and the peri-operative management of patients with coronary stents and provides an algorithm for patient management based on multidisciplinary assessment of bleeding risk, perioperative cardiac event and stent thrombosis risk.
authors.affiliation: The Prince Charles Hospital, Brisbane, Queensland, Australia. brendanbell77@hotmail.com
authors.forename: Brendan
authors.initials: B
authors.lastname: Bell
authors.forename: Jamie
authors.initials: J
authors.lastname: Layland
authors.forename: Karl
authors.initials: K
authors.lastname: Poon
authors.forename: Christian
authors.initials: C
authors.lastname: Spaulding
authors.forename: Darren
authors.initials: D
authors.lastname: Walters
mesh_terms: D054855:Drug-Eluting Stents; D006801:Humans; D009203:Myocardial Infarction / Q000517:prevention & control*; D015425:Myocardial Reperfusion; D019990:Perioperative Care / Q000379:methods* / Q000592:standards; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011725:Pyridines / Q000627:therapeutic use*; D012307:Risk Factors; D013927:Thrombosis / Q000517:prevention & control*; D013997:Time Factors
chemical_list: D010975:Platelet Aggregation Inhibitors; D011725:Pyridines; C446540:thienopyridine