Controversies in oral antiplatelet therapy in patients undergoing aortocoronary bypass surgery

Area of Science:

• Cardiology
• Vascular Medicine
• Pharmacology

Background:

• Oral antiplatelet therapy, including aspirin and clopidogrel, is crucial for preventing thrombotic events in acute coronary syndromes and after percutaneous coronary interventions.
• This therapy, while effective, presents challenges due to irreversible platelet inhibition and the risk of ischemic events upon premature drug withdrawal, particularly in patients with drug-eluting stents.

Purpose of the Study:

• To review the critical role of platelets in ischemic events.
• To evaluate the significance of dual antiplatelet therapy (DAPT).
• To examine the risks associated with DAPT withdrawal in patients requiring coronary artery bypass grafting (CABG) and discuss future directions.

Main Methods:

• Literature review focusing on platelet function, antiplatelet agents, and surgical outcomes.
• Analysis of clinical data regarding ischemic events and bleeding complications.
• Synthesis of evidence on managing antiplatelet therapy in patients undergoing major cardiovascular procedures.

Main Results:

• Platelets are central to the pathogenesis of arterial thrombosis and ischemic events.
• DAPT demonstrates significant efficacy but necessitates careful management around surgical procedures.
• Premature cessation of DAPT, especially after drug-eluting stent placement, is linked to increased risk of stent thrombosis and myocardial infarction.

Conclusions:

• Managing dual antiplatelet therapy in patients requiring coronary artery bypass grafting is complex, balancing ischemic and bleeding risks.
• Strategies for perioperative antiplatelet management are essential to optimize patient outcomes.
• Further research is needed to refine guidelines for DAPT discontinuation and resumption around surgical interventions.