Management of perioperative stent thrombosis in patients undergoing surgery

Platelets
Boris BigalkeMeinrad Gawaz

Abstract

Surgery often requires the interruption of standard dual antiplatelet therapy using aspirin and clopidogrel. Here, we present three patients who underwent surgery and suffered from a perioperative stent thrombosis associated with premature discontinuation of dual antiplatelet therapy. Although there are missing evidence-based data and key guidelines, we suggest that patients who undergo surgery after coronary stenting may benefit from an individualized perioperative antiplatelet management strategy. After premature dual antiplatelet therapy discontinuation, when the bridging of the preoperative time interval with the use of a short acting intravenous glycoprotein (GP) IIb-IIIa inhibitor including a platelet function testing has been missed and a coronary stent thrombosis has occurred, the patients should be administered a GPIIb-IIIa inhibitor for 12–24 hours, followed by aspirin for one day and a dual antiplatelet treatment after 24–48 hours. Our patients benefited from this individualized practical approach.

References

Jul 24, 2003·Journal of the American College of Cardiology·Stephanie H WilsonPeter B Berger
May 5, 2005·JAMA : the Journal of the American Medical Association·Ioannis IakovouAntonio Colombo
Nov 7, 2006·Journal of the American College of Cardiology·Daniel A WaxmanGregg Husk
Mar 14, 2009·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Boris BigalkeAndreas E May
May 28, 2009·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Marc Cohen

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Citations

Oct 7, 2011·Medizinische Klinik, Intensivmedizin und Notfallmedizin·A VogtA Plehn

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