Perioperative antiplatelet therapy in patients at risk for coronary stent thrombosis undergoing noncardiac surgery

Abstract

Sirs:Premature discontinuation of antiplatelet therapy is themost important predictor of thrombotic events after coro-nary stent implantation [5]. However, noncardiac surgeryoften requires the interruption of the standard dual-anti-platelet therapy using aspirin (75–100 mg/day) andclopidogrel (75 mg/day). Even though the problem for theperioperative management of these particular high-riskpatients has been addressed in guidelines, no clear rec-ommendation for high-risk patients is given in thoseguidelines [3, 10].Here we report on seven patients at high-risk for bothperioperative bleeding and stent thrombosis, respectively.In these patients the peri- and postoperative time interval ofthe interruption of dual-oral-antiplatelet therapy has beenbridged by using a short-acting intravenous GPIIb–IIIa-inhibitor. The demographic details are shown in Table 1.A3-month follow-up has been performed by telephoneinterview.Patient 1, a 71-year-old man, presented with a tibialimpression fracture after a car accident. He had a history ofcoronary artery bypass graft surgery plus a thrombarterec-tomyoftheleftcarotidarteryin2000.Whenhewasadmittedto the hospital for surgical tibial fracture realignment, thepatient developed an acute coronary syndrome (ACS). TheECGshowed anatrialfibrillation of90beatsperminutewithsignsofaformer inferiorwall myocardialinfarction(Qwave