Perioperative management of the patient with a coronary stent

Abstract

In recent years, an increasing number of patients have received coronary stents as a treatment for coronary artery disease. It is expected that more such patients will present to the operating room. The purpose of this review is to highlight the key issues and provide possible management strategies for these patients. Currently published studies suggest that patients with coronary stents, and in particular those with drug-eluting stents, are at an increased risk of perioperative cardiac morbidity and mortality due to stent thrombosis. Total and premature discontinuation of dual antiplatelet therapy (aspirin and clopidogrel) is considered as the main culprit. Caring for patients with coronary stents in the perioperative period requires input from a team consisting of anesthesiologists, surgeons and cardiologists. The management of the dual antiplatelet therapy regimen should be customized to each patient depending on the type and urgency of surgery, type of coronary stent, time since the coronary intervention and complexity of the coronary intervention. For patients identified at high risk for stent thrombosis, surgery should be planned in a hospital with cardiac catheterization facilities. Postoperatively, these patients require a monitored setting and their antiplatelet agents restarted immediately. Signs and symptoms of stent thrombosis should be promptly recognized and aggressively treated with percutaneous coronary intervention.