title: Perioperative management of dual anti-platelet therapy.
abstract: Dual anti-platelet therapy denotes a regimen of aspirin plus a P2Y12receptor inhibitor, clopidogrel, prasugrel, or ticagrelor. Such therapy is a cornerstone of medical management following acute coronary syndromes and is imperative following percutaneous coronary interventions. While there is uncertainty about the optimal duration of dual antiplatelet therapy following percutaneous coronary intervention, the new 2016 American College of Cardiology/American Heart Association Guidelines suggest that for patients with stable ischemic heart disease at least six months of such therapy following a drug eluting stent and one month following a bare metal stent should be implemented. In patients with acute coronary syndrome including non-ST elevation and ST elevation myocardial infarction it is recommended to extend dual antiplatelet therapy treatment to one year in both drug eluting stent and bare metal stent groups. There may be latitude for earlier discontinuation in appropriately selected patients; extended dual antiplatelet therapy beyond one year may be beneficial in others. Herein, we describe current guidelines and evidence supporting if and when dual antiplatelet therapy should be interrupted for surgery for patients who have undergone percutaneous coronary intervention.
authors.affiliation: a Department of Internal Medicine , The Icahn School of Medicine at Mount Sinai , New York , NY , USA.
authors.forename: Tyler D
authors.initials: TD
authors.lastname: Webster
authors.affiliation: b The Mount Sinai Hospital Cardiovascular Institute , New York , NY , USA.
authors.forename: Prashant
authors.initials: P
authors.lastname: Vaishnava
authors.affiliation: c Sam and Jean Frankel Cardiovascular Institute , University of Michigan Health System , Ann Arbor , MI , USA.
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy; D001241:Aspirin / Q000008:administration & dosage* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D017558:Elective Surgical Procedures / Q000379:methods; D006801:Humans; D017202:Myocardial Ischemia / Q000188:drug therapy* / Q000601:surgery; D062645:Percutaneous Coronary Intervention / Q000379:methods; D019990:Perioperative Care / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage* / Q000627:therapeutic use; D013997:Time Factors; D014481:United States
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D001241:Aspirin
keywords: DAPT; Dual-Antiplatelet Therapy; PCI; aspirin; bridging; clopidogrel; discontinuation; perioperative; surgery