Related Experiment Video
Updated: May 26, 2026
08:09
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Coronary stent management in elective genitourinary surgery.
Angela D Gupta1, Michael Streiff, Jon Resar
1Departments of Urology, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA. agupta45@jhmi.edu
BJU International
|December 24, 2011
Summary
Patients with coronary stents undergoing urological surgery require careful management of antiplatelet therapy. This protocol guides decisions based on procedure bleeding risk to balance stent thrombosis and surgical bleeding risks.
Area of Science:
- Cardiology
- Urology
- Surgical Management
Background:
- Dual antiplatelet therapy (DAPT) withdrawal post-stenting increases adverse coronary events.
- Patients with coronary stents undergoing surgery face increased bleeding risks.
- Multidisciplinary management is crucial for patients with coronary stents needing urological procedures.
Purpose of the Study:
- To review literature on coronary stents and genitourinary surgery.
- To provide a perioperative management protocol for patients with coronary stents undergoing urological procedures.
Main Methods:
- Literature search using keywords: 'elective surgery', 'aspirin', 'clopidogrel', 'guidelines for percutaneous coronary intervention', 'antiplatelet therapy after coronary stent placement'.
- Classification of urological procedures into low-, moderate-, and high-bleeding risk categories.
- Development of a protocol based on stent type, procedure risk, and timing.
Main Results:
- Elective procedures should be delayed: 1 month (bare-metal stent) and 1 year (drug-eluting stent).
- Low-risk procedures: Continue aspirin; DAPT 24-48h post-op if no bleeding.
- Moderate-risk procedures: Discontinue DAPT 5-7 days pre-op, resume within 7 days.
- High-risk procedures: Discontinue DAPT 10 days pre-op, resume within 7-10 days.
Conclusions:
- A multidisciplinary approach and a risk-stratified protocol enable safe surgical intervention.
- The protocol aims to balance the risks of stent thrombosis and surgical bleeding.
- Adequate stent endothelialization is key for safe surgical intervention.
Related Concept Videos
01:25Urinary Tract Calculi VI: Surgical Management
Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
01:30Urinary Tract Calculi III: Medical Management
The diagnosis of renal calculi involves several imaging techniques, including non-contrast CT scans and ultrasound. These methods help visualize kidney stones, assess their size and location, and detect possible obstructions. Additionally, Measuring urine pH is useful for diagnosing specific stone types, such as struvite (alkaline pH) and uric acid stones (acidic pH). Cystine stones are primarily linked to cystinuria, a genetic condition. A urinalysis helps detect blood in the urine (hematuria)...
01:28Urinary Tract Calculi V: Nursing Management
AssessmentSubjective Data: Obtain a detailed health history, including any recent or chronic urinary tract infections, periods of immobilization, previous episodes of renal calculi, and medical conditions such as gout, benign prostatic hyperplasia, or hyperparathyroidism. Review the medication history for drugs that may influence stone formation, including allopurinol, analgesics, loop diuretics, or thiazide diuretics. Document the use of long-term indwelling catheters and any past surgical...
01:26Cardiac Catheterization IV: Nursing Management
Nursing responsibilities before cardiac catheterization include:Assess for allergies and establish baseline health status.Before cardiac catheterization, assess the patient for allergies to contrast dye. Perform a comprehensive baseline assessment, including vital signs, heart and breath sounds, and a neurovascular assessment of the extremities, noting distal pulses, skin color, and temperature. Instruct the patient to fast for 8-12 hours before the procedure. Evaluate baseline laboratory...
01:28Acute Coronary Syndrome IV: Interprofessional Care
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
01:22Aneurysm IV: Nursing Management
Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...