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Published on: May 14, 2013
Drug-eluting stent thrombosis in patients undergoing non-cardiac surgery: is it always a problem?
G Godet1, Y Le Manach, F Lesache
1Department of Anesthesiology and Critical Care, Centre Hospitalo-Universitaire Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France. gilles.godet@chu-rennes.fr
Insights
Patients with drug-eluting stents (DES) face high cardiac risks after surgery. However, careful management of anti-platelet drugs can minimize specific DES thrombotic complications, though overall cardiac risk remains elevated due to comorbidities.
Area of Science:
- Cardiology
- Interventional Cardiology
- Perioperative Medicine
Background:
- Drug-eluting stents (DES) are associated with a high incidence of perioperative complications.
- Current recommendations for bare-metal stents (BMS) do not apply to DES.
- Evidence-based studies for perioperative management of DES patients are limited.
Purpose of the Study:
- To evaluate the postoperative cardiac risk in patients with DES.
- To assess the incidence of cardiac complications and in-stent thrombosis after non-cardiac surgery in DES patients.
Main Methods:
- Prospective study of 96 consecutive patients with DES undergoing major non-cardiac surgery.
- Analysis of postoperative troponin release (≥0.15 ng/mL) and in-stent thrombosis.
- Average delay between revascularization and surgery was 14 months.
Main Results:
- 12% of patients experienced postoperative troponin release, mostly without EKG changes.
- 2% of patients developed in-stent thrombosis.
- No patients had excessive postoperative bleeding.
Conclusions:
- DES patients have an increased risk of postoperative cardiac complications.
- Specific DES thrombotic complications were infrequent in this study.
- Balanced perioperative anti-platelet management reduces thrombosis risk, but comorbidities contribute to overall high cardiac risk.
Background:
Recent publications have reported high incidence of perioperative complications in patients with drug-eluting stent (DES). The recommendations for bare-metal stents (BMS) are not applicable to DES. In fact, large evidence-based studies are lacking on which to base a consensus for the perioperative management of patients with DES. The aim of the present study is to evaluate the postoperative cardiac risk associated with DES.
Methods:
Prospectively collected data were examined for the rate of postoperative cardiac complications in 96 consecutive patients with DES who underwent digestive, urologic, orthopaedic, or vascular surgery. The average delay between revascularization and non-cardiac surgery was 14 (11) months (extremes 1 week and 36 months). The occurrence of postoperative troponin release (troponin I > or =0.15 ng ml(-1)) and the rate of in-stent thrombosis were analysed.
Results:
Twelve patients (12%) presented a postoperative troponin release, without EKG abnormalities in 10 cases (83%). Two patients (2%) developed an in-stent thrombosis. None of the patients had excessive postoperative blood loss.
Conclusions:
Patients with DES are at higher risk of postoperative cardiac complications. Nevertheless, the specific thrombotic complications of the DES were uncommon in this series and this is in contrast to previous alarming reports. A balanced perioperative management of anti-platelet agents, considering both risk for bleeding and risk of thrombotic complications, in patients with DES, is associated with a low risk of thrombosis in the postoperative period. The rate of cardiac complications remains high in these patients due to co-morbidities.
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