[Antiplatelet therapy after coronary stenting and its importance in total joint arthroplasty].
Coronary stenting is an effective treatment for reopening atherosclerotic occlusions of coronary arteries. Depending on the manifestation of coronary artery disease (stable CAD or acute coronary syndrome) and on the type of implanted stent, dual antiplatelet therapy is recommended for a period of 4 weeks to 12 months. In this period total joint replacement is associated with high blood loss and high perioperative morbidity. Therefore antiplatelet therapy is often discontinued and replaced by higher dosages of heparin for prophylactic anticoagulation. However, with this treatment regimen protection of the stent is doubtful and there is a high risk of stent thrombosis with myocardial infarction. The surgery should be scheduled after the dual antiplatelet therapy is replaced by lifelong aspirin therapy. On the other hand, if surgery cannot be postponed perioperative bridging of dual antiplatelet therapy can be conducted to minimize bleeding complications with the best possible stent protection. Lifelong therapy with aspirin should not be discontinued in any case.
Klinik für Orthopädie und Sportorthopädie, Klinikum Rechts der Isar, Technische Universität, Ismaninger Str. 22, 81675, München, Deutschland. norbert.harrasser@gmx.net
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Harrasser
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Harnoss
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Brettner
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Liska
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Pauschinger
D015906:Angioplasty, Balloon, Coronary; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use; D016063:Blood Loss, Surgical; D015897:Comorbidity; D003327:Coronary Disease / Q000097:blood / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D006470:Hemorrhage / Q000097:blood / Q000139:chemically induced / Q000517:prevention & control; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008134:Long-Term Care; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use*; D010979:Platelet Function Tests; D011183:Postoperative Complications / Q000097:blood / Q000188:drug therapy*; D012086:Reoperation; D015607:Stents
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D006493:Heparin; D001241:Aspirin