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Noncardiac surgery after percutaneous coronary intervention

Authors
Donald Cutlip, MD
Stephan Windecker, MD
Steven L Cohn, MD, FACP, SFHM
Section Editors
Juan Carlos Kaski, DSc, MD, DM (Hons), FRCP, FESC, FACC, FAHA
Patricia A Pellikka, MD, FACC, FAHA, FASE
Deputy Editor
Gordon M Saperia, MD, FACC

INTRODUCTION

The management of antiplatelet therapy in patients who need noncardiac surgery after percutaneous coronary intervention (PCI) with stenting requires consideration of the competing risks of acute coronary events with premature cessation and bleeding with continuation of antiplatelet therapy. This is an important clinical problem, as it is estimated that about 5 to 10 percent of patients with coronary stents undergo noncardiac surgery within one year of stent implantation [1-5].

This topic will focus on the approach to patients scheduled to undergo elective noncardiac surgery after PCI with stenting and who are taking dual antiplatelet therapy. Patients who require urgent or emergent surgery or those who receive balloon angioplasty are also discussed briefly. The approach to antiplatelet therapy in patients scheduled for coronary artery bypass graft surgery is presented separately. (See "Medical therapy to prevent complications after coronary artery bypass graft surgery", section on 'Preoperative aspirin' and "Medical therapy to prevent complications after coronary artery bypass graft surgery", section on 'Platelet P2Y12 receptor blocker therapy'.)

The larger discussion of the risk of coronary artery stent thrombosis, one of the potential complications of discontinuing antiplatelet therapy prior to noncardiac surgery, is found elsewhere. (See "Long-term antiplatelet therapy after coronary artery stenting in stable patients" and "Coronary artery stent thrombosis: Incidence and risk factors".)

DEFINITIONS

For this topic, major surgery is defined as any surgery for which the surgeon might recommend the discontinuation of dual antiplatelet therapy due to a concern for an increase in bleeding risk. Most studies that have evaluated this issue have included patients scheduled to undergo peripheral arterial, orthopedic, abdominal, or thoracic surgery, or radical prostatectomy, nephrectomy, or cystectomy.

Dual antiplatelet therapy refers to the combination of aspirin plus a P2Y12 receptor blocker such as clopidogrel, prasugrel, or ticagrelor.

              
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Literature review current through: Sep 2017. | This topic last updated: May 19, 2016.
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