Management of patients with cardiac stents undergoing noncardiac surgery
Current Opinion in Anaesthesiology , Volume 20 - Issue 3 p. 274- 278
PURPOSE OF REVIEW: Coronary stenting is performed in over 4 million patients annually. Approximately 5% of these patients undergo a noncardiac surgical procedure within 1 year after stenting. Surgery might induce hypercoagulability. This causes increased concern about the effects of previous coronary stenting on postoperative cardiac outcome, particularly in-stent thrombosis. On the other hand, patients with multiple cardiac risk factors are at high risk for postoperative adverse cardiac events and might even benefit from preoperative prophylactic coronary revascularization. RECENT FINDINGS: Early noncardiac surgery after coronary stent placement is associated with an increased risk of major adverse cardiac events. The majority of these events are attributable to in-stent thrombosis. Antiplatelet therapy interruption in the perioperative period seems to be associated with an increase in adverse cardiac events, particularly in patients who undergo noncardiac surgery early after coronary stenting. Furthermore, prophylactic coronary revascularization for high cardiac risk patients is not associated with an improved outcome. SUMMARY: Early noncardiac surgery after coronary stenting increases the risk of postoperative cardiac events. Interruption of antiplatelet therapy seems to play an important role in this increased event rate. Prophylactic coronary revascularization in cardiac stable, but high-risk patients does not seem to improve outcome.
|Antiplatelet therapy, Bleeding, Coronary stents, Noncardiac surgery, Stent thrombosis|
|Current Opinion in Anaesthesiology|
|Organisation||Erasmus MC: University Medical Center Rotterdam|
Schouten, O, Bax, J.J, & Poldermans, D. (2007). Management of patients with cardiac stents undergoing noncardiac surgery. Current Opinion in Anaesthesiology (Vol. 20, pp. 274–278). doi:10.1097/ACO.0b013e328105dac5