title: Use of Antiplatelet Therapy/DAPT for Post-PCI Patients Undergoing Noncardiac Surgery.
abstract: Dual antiplatelet therapy (DAPT) is prescribed to millions of patients worldwide following coronary stenting. DAPT is indicated to lower the risk of ischemic events, such as myocardial infarction, including stent thrombosis, ischemic stroke, or death from cardiovascular causes. A significant number of these patients undergo noncardiac surgery and may require DAPT interruption. This poses a significant clinical dilemma because DAPT interruption exposes patients to the potential risk of stent thrombosis, perioperative myocardial infarction, or both. Conversely, continuing DAPT may be associated with excess bleeding complications. Observational data in this area are conflicting, and there are no randomized clinical trials to guide practitioner decision making. On the basis of predominantly consensus recommendations, various strategies for managing DAPT during the perioperative period have been proposed. This review presents 3 commonly encountered clinical scenarios that lead into an evidence-based discussion of practical strategies for managing perioperative antiplatelet therapy in patients following percutaneous coronary intervention.
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, Texas; Veterans Affairs North Texas Health Care System, Dallas, Texas. Electronic address: subhash.banerjee@utsouthwestern.edu.
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: University of Florida College of Medicine-Jacksonville, Jacksonville, Florida.
authors.forename: Dominick J
authors.initials: DJ
authors.lastname: Angiolillo
authors.affiliation: Veterans Affairs New England Healthcare System, Boston, Massachusetts.
authors.forename: William E
authors.initials: WE
authors.lastname: Boden
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Murphy
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, Texas; Veterans Affairs North Texas Health Care System, Dallas, Texas.
authors.forename: Houman
authors.initials: H
authors.lastname: Khalili
authors.affiliation: National Heart, Lung, and Blood Institute, Bethesda, Maryland.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Hasan
authors.affiliation: Stanford University School of Medicine, Stanford, California.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Harrington
authors.affiliation: Duke University School of Medicine, Durham, North Carolina; Durham VA Medical Center, Durham, North Carolina.
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D019990:Perioperative Care; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: aspirin; coronary balloon angioplasty; drug-eluting stents; risk assessment; stents; thrombosis