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: Brendan Bell, Jamie Layland, Karl Poon, Christian Spaulding, Darren Walters
• Journal: Heart, lung & circulation (Heart Lung Circ) Vol. 20 Issue 7 Pg. 438-45 (Jul 2011) ISSN: 1444-2892 [Electronic] Australia
• PMID: 21493140 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2011 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Published by Elsevier B.V. All rights reserved.

Chemical References

• Platelet Aggregation Inhibitors
• Pyridines
• thienopyridine

Topics

• Drug-Eluting Stents
• Humans
• Myocardial Infarction (prevention & control)
• Myocardial Reperfusion
• Perioperative Care (methods, standards)
• Platelet Aggregation Inhibitors (therapeutic use)
• Pyridines (therapeutic use)
• Risk Factors
• Thrombosis (prevention & control)
• Time Factors