Drug-Eluting Stent Thrombosis During Perioperative Period

Abstract

SUMMARYRecently, the number of patients in whom a drug-eluting stent (DES) has recently been implanted and who need to undergo surgery or the most invasive procedure is increasing. However, there are limited data about the risk of perioperative thrombosis of DES. We evaluated the incidence and the risk factors of DES thrombosis during the perioperative period.Between January 2002 and December 2006, 141 patients who underwent surgery requiring discontinuation of a dual antiplatelet agent within 12 months of DES implantation were enrolled in one of the 3 study hospitals. We reviewed the clinical and procedural characteristics of the patients who developed stent thrombosis during the perioperative period.Stent thrombosis occurred in 7 cases (5.0%). The clinical outcomes of the patients with stent thrombosis were death in 5 cases and nonfatal MI in 2 cases. The patients with stent thrombosis were found to be older (64.2 ± 9.7 versus 71.7 ± 6.0 years, P = 0.045), to use a Taxus stent more frequently (36.6 versus 85.7%, P = 0.014), and to have a more prolonged period of discontinuation of clopidogrel (12.7 ± 10.0 versus 51.3 ± 33.2 days, P = 0.022) than the patients without stent thrombosis. Multivariate analysis revealed that 7 days or longer discontinuation of clopidogrel (OR 12.8, 95% CI 1.3-121.6, P = 0.021) and the use of a Taxus stent (OR 10.2, 95% CI 1.1-95.7, P = 0.043) were significant independent predictors of stent thrombosis during the perioperative period.A prolonged period of discontinuation of clopidogrel was associated with higher risk of stent thrombosis during the perioperative period. An earnest effort to continue antiplatelet therapy throughout the perioperative period can minimize the risk of stent thrombosis. (Int Heart J 2008; 49: 135-142)

2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery

“…[108][109][110][111][112][113] The risk relates to the nature of the underlying ACHD, the surgical procedure, and the urgency of intervention. [108][109][110][111][112][113] For more information, readers are referred to the specific recommendations for perioperative assessment in the ACC/AHA 2008 ACHD CPG.…”

“…[108][109][110][111][112][113] The risk relates to the nature of the underlying ACHD, the surgical procedure, and the urgency of intervention. [108][109][110][111][112][113] For more information, readers are referred to the specific recommendations for perioperative assessment in the ACC/AHA 2008 ACHD CPG. 28 When possible, it is optimal to perform the preoperative evaluation of surgery for patients with ACHD in a regional center specializing in congenital cardiology, particularly for patient populations that appear to be at particularly high risk (eg, those with a prior Fontan procedure, cyanotic ACHD, pulmonary arterial hypertension, clinical HF, or significant dysrhythmia).…”

Direct Stenting Versus Predilatation and Stenting Technique When Using Paclitaxel-Eluting Stents

“…Analysis of coronary angiography records in these 3 patients revealed that two cases were due to stent thrombosis in the predilatation group and one was due to stent thrombosis in the direct stenting group (1.1% versus 1.2%, P = NS). Although it has been reported that DES thrombosis risk is particularly increased during the perioperative period of noncardiac surgery following DES implantation, 15) none of our patients who had stent thrombosis were in the perioperative period when the thrombosis occurred. Due to restenosis or stent thrombosis, 11 (4%) lesions in the predilatation group and 5 (5%) lesions in the direct stenting group underwent TVR via percutaneous coronary intervention (P = NS).…”

Current Practices in the Management of Antithrombotic Therapy During the Periendoscopic Period for Patients With Cardiovascular Disease

“…Additionally, single antiplatelet therapy after DAPT is controversial because thienopyridine derivatives are reported to be more effective in preventing stent thrombosis compared with aspirin. [34][35][36][37] Moreover, the use of biodegradable stents in coronary arteries may bring about a massive change in the use of antithrombotics. [38][39][40] To ensure that upcoming guidelines are comprehensive, it will be necessary to be able to respond flexibly to upcoming trends in the treatment of cardiovascular disease.…”