Related Experiment Videos
Use of Antiplatelet Therapy/DAPT for Post-PCI Patients Undergoing Noncardiac Surgery
Subhash Banerjee1, Dominick J Angiolillo2, William E Boden3
1University of Texas Southwestern Medical Center, Dallas, Texas; Veterans Affairs North Texas Health Care System, Dallas, Texas.
Insights
Managing dual antiplatelet therapy (DAPT) after coronary stenting during noncardiac surgery presents a dilemma. This review offers evidence-based strategies for perioperative antiplatelet management to balance risks of thrombosis and bleeding.
Area of Science:
- Cardiology
- Vascular Medicine
- Surgical Management
Background:
- Dual antiplatelet therapy (DAPT) is crucial for patients post-percutaneous coronary intervention (PCI) to prevent ischemic events.
- Millions of patients require noncardiac surgery, necessitating decisions about continuing or interrupting DAPT.
Observation:
- Interruption of DAPT increases risks of stent thrombosis and perioperative myocardial infarction.
- Continuing DAPT during surgery may lead to significant bleeding complications.
- Current evidence is limited, with conflicting observational data and no randomized trials.
Findings:
- Management strategies are primarily based on consensus recommendations.
- The review discusses practical approaches for three common clinical scenarios.
- An evidence-based discussion guides decision-making for perioperative antiplatelet therapy.
Implications:
- Provides clinicians with practical strategies for managing DAPT in surgical patients.
- Aims to optimize patient outcomes by mitigating risks of both thrombotic and bleeding events.
- Highlights the need for further research to establish definitive guidelines for perioperative DAPT management.
Abstract:
Dual antiplatelet therapy (DAPT) is prescribed to millions of patients worldwide following coronary stenting. DAPT is indicated to lower the risk of ischemic events, such as myocardial infarction, including stent thrombosis, ischemic stroke, or death from cardiovascular causes. A significant number of these patients undergo noncardiac surgery and may require DAPT interruption. This poses a significant clinical dilemma because DAPT interruption exposes patients to the potential risk of stent thrombosis, perioperative myocardial infarction, or both. Conversely, continuing DAPT may be associated with excess bleeding complications. Observational data in this area are conflicting, and there are no randomized clinical trials to guide practitioner decision making. On the basis of predominantly consensus recommendations, various strategies for managing DAPT during the perioperative period have been proposed. This review presents 3 commonly encountered clinical scenarios that lead into an evidence-based discussion of practical strategies for managing perioperative antiplatelet therapy in patients following percutaneous coronary intervention.