Focused Clinical Review: Periprocedural Management of Antiplatelet Therapy in Patients with Coronary Stents

Brendan Bell, Jamie Layland, Karl Poon, Christian Spaulding, Darren Walters

Research output: Contribution to journalReview ArticleResearchpeer-review

6 Citations (Scopus)

Abstract

Coronary stent implantation, particularly drug eluting stents, is now the major method of coronary revascularisation. Following drug-eluting stent implantation dual antiplatelet therapy with aspirin and thienopyridine is recommended for at least 12 months. Premature discontinuation, often at the time of noncardiac surgery, has been associated with stent thrombosis which has a significant risk of death and myocardial infarction. Late (>30 days) and very late (>365 days) stent thrombosis appears to more common with DES and poses the questions of when is it safe to stop antiplatelet therapy post coronary stenting and how to manage patients who need non-cardiac surgery. This article reviews the evidence for stent thrombosis and the peri-operative management of patients with coronary stents and provides an algorithm for patient management based on multidisciplinary assessment of bleeding risk, perioperative cardiac event and stent thrombosis risk.

Original languageEnglish
Pages (from-to)438-445
Number of pages8
JournalHeart Lung and Circulation
Volume20
Issue number7
DOIs
Publication statusPublished - 1 Jul 2011
Externally publishedYes

Keywords

  • Drug-eluting stent
  • Dual antiplatelet therapy
  • Stent thrombosis

Cite this