Withdrawal Of Antiplatelet Therapy Research Articles

Consequences of coronary artery stenting for non‐cardiac surgery

SUMMARYPercutaneous coronary intervention with intracoronary stenting is a routine procedure in the treatment of coronary artery disease today. While complication rates of in‐stent stenosis and thromboembolic complications dropped over the years due to improved stent design, material, coating and consequent antiplatelet medication, major concerns remain relating to non‐cardiac surgery following briefly after coronary artery stent implantation. A mortality rate of almost 5% has to be expected in a mixed surgical and orthopedic population after coronary artery stenting. Data about cardiac surgery briefly after stent implantation are not available. The risk of major bleeding following continued perioperative antiplatelet therapy has to be balanced against the risk of stent thrombosis by discontinuation of antiplatelet medication in these patients. The careless withdrawal of antiplatelet therapy preoperatively must be avoided.

Rescue Percutaneous Coronary Intervention Early After Coronary Artery Bypass Grafting in the Drug-Eluting Stent Era

Ten patients underwent rescue percutaneous coronary intervention for myocardial infarction or ischemia soon after coronary artery bypass grafting, and 6 received drug-eluting stents (DESs). Outcomes were limited primarily by bleeding events. There was 1 episode of DES thrombosis after antiplatelet therapy was discontinued due to gastrointestinal hemorrhage. Rescue percutaneous coronary intervention is a feasible approach to reestablish coronary perfusion in the perioperative period, but DESs should be used only after appropriate risk stratification for potential bleeding complications that may require the withdrawal of antiplatelet therapy.