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[Perioperative discontinuation of antiplatelet therapy of patients with coronary stents. Reevaluating the risks]

J Graw1, W Schwenk, T Volk

  • 1Universitätsklinik für Anästhesiologie und Operative Intensivmedizin, Campus Virchow Klinikum und Campus Mitte, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.

Der Chirurg; Zeitschrift Fur Alle Gebiete Der Operativen Medizen
|November 18, 2008
PubMed

Insights

Patients with coronary stents need dual antiplatelet therapy. Withdrawing this medication for surgery risks fatal stent thrombosis, while continuing it risks bleeding. Acetylsalicylic acid has a low hemorrhagic risk and should only be stopped in select cases.

Area of Science:

  • Cardiology
  • Vascular Surgery

Background:

  • Current guidelines recommend dual antiplatelet therapy for patients with coronary stents.
  • Perioperative management requires balancing stent thrombosis risk against bleeding risk.

Purpose of the Study:

  • To discuss the case of a fatal stent thrombosis.
  • To review evidence on perioperative antiplatelet therapy management in stented patients.

Main Methods:

  • Case report presentation.
  • Literature review of current evidence on antiplatelet therapy interruption and continuation.

Main Results:

  • Fatal stent thrombosis occurred after antithrombotic withdrawal.
  • Hemorrhagic risk associated with acetylsalicylic acid for secondary prevention appears low.
  • Discontinuation of acetylsalicylic acid is recommended only in selected cases.

Conclusions:

  • Individualized risk assessment is crucial for managing antiplatelet therapy in stented patients undergoing surgery.
  • Continued dual anticoagulation strategies warrant further discussion and investigation.

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