Thrombozytenfunktionshemmung nach koronarer Stentimplantation: Bedeutung in der Endoprothetik

Harrasser, Norbert; Harnoss, Tobias; Brettner, Florian; Liska, Franz; Pauschinger, Matthias

doi:10.1007/s00132-012-1900-4

Cited by 2 publications

(2 citation statements)

References 32 publications

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“…One study reported that nondiscontinuation of aspirin during spinal surgery after PCI did not increase perioperative bleeding. [22] Furthermore, another study reported that heparin was ineffective as a replacement for DAPT [23] ; thus, it was suggested that aspirin should be continued for life after PCI and should not be discontinued during the perioperative period of joint replacement. [23]…”

Section: Discussionmentioning

confidence: 99%

Risk of bleeding in patients with continued dual antiplatelet therapy during orthopedic surgery

Hai

Tang

et al. 2019

Chinese Medical Journal

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Background: To prevent risk of life-threatening stent thrombosis, all patients need to undergo dual antiplatelet therapy (DAPT) for at least 6 weeks to 12 months after stent implantation. If DAPT is continued during noncardiac surgery, there is a risk of severe bleeding at the surgical site. Our study was to assess the risk of bleeding in patients with continued DAPT during orthopedic surgery. Methods: The clinical data of 78 patients with coronary heart disease who underwent orthopedic surgery from February 2006 to July 2018 were retrospectively analyzed. Prior to orthopedic surgery, DAPT was continued in 16 patients (group I), 24 patients were treated with single antiplatelet therapy (group II), and 26 patients received low-molecular-weight heparin therapy for more than 5 days after the discontinuation of all antiplatelet therapies (group III). Twelve patients were excluded, as they had undergone minimally invasive surgery such as transforaminal endoscopy and vertebroplasty. The perioperative blood loss of each patient was calculated using Nadler's formula and Gross’ formula. The intraoperative bleeding volume, total volume of intraoperative bleeding in addition to postoperative drainage, and total blood loss were compared between groups. The level of significance was set at P < 0.05. Results: There were no significant differences between the three groups in age, intraoperative bleeding volume, total volume of intraoperative bleeding in addition to postoperative drainage, and total perioperative blood loss calculated by Nadler's formula and Gross’ formula (all P > 0.05). Six patients experienced postoperative cardiovascular complications due to the delayed restart of antiplatelet therapy; one of these patients in group III died from myocardial infarction. Conclusions: Continued DAPT or single antiplatelet treatment during orthopedic surgery does not increase the total intraoperative and perioperative bleeding compared with switching from antiplatelet therapy to low-molecular-weight heparin. However, the discontinuation of antiplatelet therapy increases the risk of serious cardiac complications.

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Section: Discussionmentioning

confidence: 99%

Risk of bleeding in patients with continued dual antiplatelet therapy during orthopedic surgery

Hai

Tang

et al. 2019

Chinese Medical Journal

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“…There are certain red flags that require a cardiology referral, such as patients with poorly controlled HTN and a previous history of coronary stents, bypass, or MI. 40 The cardiologist can weigh in regarding the preoperative use of aspirin and clopidogrel 41 and devise an anticoagulation plan (whether to stop, a bridging plan if necessary, and the timing of medication). Patients requiring long-term anticoagulation must have a schedule dictating when to pause and how to bridge their medication from their cardiologist.…”

Section: Strategies To Optimize Patients Before Surgerymentioning

confidence: 99%

Movement Is Life—Optimizing Patient Access to Total Joint Arthroplasty: Cardiovascular Health Disparities

Wiznia¹,

Santos²,

Morgan³

2022

J Am Acad Orthop Surg

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Cardiovascular disease includes a collection of conditions with 6.7% of American adults having coronary artery disease and 45% having hypertension. Proper management of these conditions is low (<25%). Hypertension is highest among African Americans and is associated with lower socioeconomic status and education level. Heart disease is associated with postoperative complications, such as cardiovascular and cerebrovascular events, pulmonary and coagulopathy complications, and mortality. Underserved communities can be optimized beginning with a thorough preoperative assessment, which includes evaluating for food security, instituting dietary modifications and exercise regimens, and improving cardiovascular health with pharmacologic modalities and specialty care. Nurse navigators can be invaluable for guiding patients through a cardiovascular preoperative optimization pathway.

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Thrombozytenfunktionshemmung nach koronarer Stentimplantation: Bedeutung in der Endoprothetik

Cited by 2 publications

References 32 publications

Risk of bleeding in patients with continued dual antiplatelet therapy during orthopedic surgery

Risk of bleeding in patients with continued dual antiplatelet therapy during orthopedic surgery

Movement Is Life—Optimizing Patient Access to Total Joint Arthroplasty: Cardiovascular Health Disparities

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