[The risk of stent thrombosis in the perioperative setting]

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Anesthesiology

Background:

• Increasing rates of percutaneous coronary interventions (PCI) necessitate long-term dual anti-platelet therapy (DAPT).
• This patient cohort faces elevated risks of severe perioperative complications, including coronary ischemia and bleeding.
• Complications arise from acute stent thrombosis or excessive blood loss, with thrombosis posing a higher risk.

Observation:

• A case report highlights challenges in managing patients on DAPT requiring surgery.
• Evidence suggests postponing elective surgery until DAPT completion is often necessary.
• Individualized, interdisciplinary approaches are crucial for semi-elective surgical candidates.

Findings:

• Stent thrombosis risk outweighs bleeding risk in DAPT patients.
• Perioperative management requires careful consideration of anti-platelet agent withdrawal.
• If clopidogrel is stopped, aspirin should be continued throughout the perioperative period.
• Minimizing surgical trauma and considering bare metal stents for procedures within 12 months are key.

Implications:

• Optimized perioperative protocols are essential for high-risk PCI patients.
• Interdisciplinary collaboration improves patient safety and surgical outcomes.
• Evidence-based guidelines aid in managing DAPT cessation and continuation strategies.