Abstract
Guidelines recommend delaying noncardiac surgery in patients after coronary stent procedures for 6 -12 months after drug-eluting stents (DES) and for 6 weeks after bare metal stents (BMS). It is often replaced by bridging heparin for the prevention of perioperative stent thrombosis in Japan, although there is no evidence for heparin replacement. The aim of this study was to investigate the perioperative complication between the patients with continuation of antiplatelet therapy (APT) and that with substitution of heparin after interruption of APT in thoracic surgery. A retrospective study was done on 75 patients after coronary stent procedures performed thoracic surgery with APT or bridging heparin in perioperative from June 2008 to October 2015. We evaluated the perioperative outcomes between the patients with APT (APT group) and that with bridging heparin interrupting APT (non APT group). Males were 13 cases (76%) and median age was 73.5 years in APT group. Fifteen cases (88%) with APT had angina in past history. The type of stent was drug eluting stent (71%), bare metal stent (24%) and biological absorption stent (6%) in APT group. Surgical procedures with wide wedge resection (12%), segmentectomy (12%), lobectomy (71%), and others (6%) were performed in APT group. Median operative time was 119 minutes and median operative blood loss was 18ml in APT group. There was no difference with operative time and blood loss in APT group compared in non APT group (p=0.128 and p=0.923). Cardiovascular events was not observed in both groups. One case had Hemothorax and reoperation in APT group and one case had hemosputum in non APT group. There was no difference in complication in both groups. Perioperative death was not observed in both groups. There was no difference between the patients with and without the discontinuation of antiplatelet agent in perioperative cardiovascular and embolic events. On the other hand, it seems that the compensatory of bleeding to continue antiplatelet agent is too large, because a few cases were forced completion pneumonectomy and acute exacerbation of interstitial pneumonia due to bleeding. Among the patients with coronary stent undergoing thoracic surgery, it might be less the benefits of the surgery with continuation of antiplatelet agent.
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