The management of patients on dual antiplatelet therapy undergoing orthopedic surgery

Area of Science:

• Cardiology
• Orthopedic Surgery
• Perioperative Medicine

Background:

• Cardiovascular disease is common in patients requiring orthopedic surgery.
• Many patients on dual antiplatelet therapy post-percutaneous coronary intervention (PCI) with stenting face management dilemmas for orthopedic procedures.
• Optimal perioperative antiplatelet therapy management for these patients remains unclear.

Purpose of the Study:

• To provide guidance on managing patients with prior PCI and stents undergoing orthopedic procedures.
• To review cardiologist and orthopedic surgeon perspectives on perioperative management.
• To analyze current guidelines from major cardiovascular and surgical societies.

Main Methods:

• Review of concerns from cardiology and orthopedic surgery viewpoints.
• Examination of current guidelines from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, and American College of Surgeons.
• Risk-benefit analysis of dual antiplatelet therapy (DAPT) discontinuation versus continuation.

Main Results:

• Discontinuation of DAPT post-PCI requires careful risk assessment for thrombosis and bleeding.
• High-thrombosis-risk patients may benefit from delayed surgery.
• Limited data suggests minimal increased mortality risk from continuing antiplatelet therapy perioperatively in orthopedic patients.

Conclusions:

• Joint assessment by cardiologists and orthopedic surgeons is essential for managing DAPT in patients undergoing orthopedic surgery post-PCI.
• Delaying surgery for high-thrombosis-risk patients is recommended when feasible.
• Continuing antiplatelet therapy perioperatively may be safe and preferable in many orthopedic surgical cases.