[Drug-eluting stents: implications for surgery patients]

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiovascular Surgery

Background:

• Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is crucial for coronary heart disease.
• DES necessitates at least one year of dual anti-platelet therapy (DAPT).
• DAPT presents significant challenges for patients requiring planned or emergency surgery.

Purpose of the Study:

• To highlight the clinical dilemma between stent thrombosis and perioperative bleeding in patients with DES.
• To emphasize the absence of evidence-based perioperative bridging therapy options.
• To underscore the necessity of an interdisciplinary approach and legal consultation for managing patients undergoing PCI.

Main Methods:

• Review of current clinical practices and challenges associated with DES implantation.
• Analysis of the risks and benefits of DAPT in the perioperative setting.
• Discussion of the need for coordinated care between cardiologists, surgeons, and legal experts.

Main Results:

• A significant dilemma exists between the risk of stent thrombosis and perioperative bleeding in DES patients.
• There is a lack of evidence-based bridging therapy protocols for the perioperative period.
• Surgical intervention is complicated by DAPT, raising legal and ethical concerns.

Conclusions:

• PCI with DES requires careful consideration of surgical implications and DAPT management.
• An interdisciplinary approach involving cardiologists, surgeons, and legal counsel is mandatory.
• Patients must be fully informed about the risks, benefits, and legal aspects related to DES and surgery.