Perioperative Antiplatelet Therapy in Patients with Coronary Stents Undergoing Elective Non-Cardiac Surgery

LIU Yi-jun, LIU Jin

Abstract

Among patients undergoing elective non-cardiac surgery (NCS), those with coronary stent implants are gradually becoming a patient group that cannot be easily overlooked. Previous history of heart disease, coronary stents and antiplatelet agents expose these patients to dual perioperative risks of thrombosis and bleeding. Formulating appropriate plans for perioperative antiplatelet therapy will help reduce the risks and ensure the safety of patients. We herein reviewed and analyzed various aspects of perioperative antiplatelet therapy for patients with coronary stent implants undergoing elective NCS, and discussed prospective research directions in the field.

 

Keywords: Coronary stents, Non-cardiac surgery, Antiplatelet therapy

 

Full Text:

PDF


References


BERGER P B， KLEIMAN N S， PENCINA M J， et al. Frequency of major noncardiac surgery and subsequent adverse events in the year after drug-eluting stent placement results from the EVENT (Evaluation of Drug-Eluting Stents and Ischemic Events) Registry. JACC Cardiovasc Interv， 2010，3(9): 920–927.

HAWN M T， GRAHAM L A， RICHMAN J S， et al. Risk of major adverse cardiac events following noncardiac surgery in patients with coronary stents. JAMA，2013，310(14): 1462–1472.

ROSSINI R， MUSUMECI G， CAPODANNO D， et al. Perioperative management of oral antiplatelet therapy and clinical outcomes in coronary stent patients undergoing surgery. Results of a multicentre registry. Thromb Haemost，2015，113(2): 272–282.

LEVINE G N， BATES E R， BITTL J A， et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines: an update of the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention， 2011 ACCF/AHA guideline for coronary artery bypass graft surgery， 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease， 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction， 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes， and 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery. Circulation， 2016， 134(10): e123−e155[2021-01-05]. https://doi.org/10.1161/CIR.0000000000000404.

ROSSINI R， TARANTINI G， MUSUMECI G， et al. A Multidisciplinary approach on the perioperative antithrombotic management of patients with coronary stents undergoing surgery: surgery after stenting 2. JACC Cardiovasc Interv，2018，11(5): 417–434.

PARK D W， KIM Y H， YUN S C， et al. Frequency, causes, predictors, and clinical significance of peri-procedural myocardial infarction following percutaneous coronary intervention. Eur Heart J，2013，34(22): 1662–1669.

HOLCOMB C N， GRAHAM L A， RICHMAN J S， et al. The incremental risk of coronary stents on postoperative adverse events: A matched cohort study. Ann Surg，2016，263(5): 924–930.

GURAJALA I， GOPINATH R. Perioperative management of patient with intracoronary stent presenting for noncardiac surgery. Ann Card Anaesth，2016，19(1): 122–131.

WITBERG G， LEV E， KORNOWSKI R. Optimal duration of dual antiplatelet therapy after coronary stent implantation. Am J Cardiol， 2015，116(10): 1631–1636.

YEH R W， SECEMSKY E A， KEREIAKES D J， et al. Development and validation of a prediction rule for benefit and harm of dual antiplatelet therapy beyond 1 year after percutaneous coronary intervention. JAMA， 2016，315(16): 1735–1749.

ROSSINI R， MUSUMECI G， VISCONTI L O， et al. Perioperative management of antiplatelet therapy in patients with coronary stents undergoing cardiac and non-cardiac surgery: A consensus document from Italian cardiological, surgical and anaesthesiological societies. Euro Intervention，2014，10(1): 38–46.

BARON T H， KAMATH P S， MCBANE R D. Management of antithrombotic therapy in patients undergoing invasive procedures. N Engl J Med，2013，368(22): 2113–2124.

MEHTA S R， YUSUF S， PETERS R J， et al. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: The PCI-CURE study. Lancet，2001，358(9281): 527–533.

STEINHUBL S R， BERGER P B， MANN J T， 3rd， et al. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: A randomized controlled trial. JAMA，2002，288(19): 2411–2420.

WIVIOTT S D， BRAUNWALD E， MCCABE C H， et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med，2007，357(20): 2001–2015.

WALLENTIN L， BECKER R C， BUDAJ A， et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med， 2009，361(11): 1045–1057.

LEE S W， PARK S W， KIM Y H， et al. Drug-eluting stenting followed by cilostazol treatment reduces late restenosis in patients with diabetes mellitus the DECLARE-DIABETES Trial (a randomized comparison of triple antiplatelet therapy with dual antiplatelet therapy after drug-eluting stent implantation in diabetic patients). J Am Coll Cardiol，2008，51(12): 1181–1187.

LEE S W， PARK S W， KIM Y H， et al. Comparison of triple versus dual antiplatelet therapy after drug-eluting stent implantation (from the DECLARE-Long trial). Am J Cardiol，2007，100(7): 1103–1108.

MEHRAN R， BABER U， SHARMA S K， et al. Ticagrelor with or without Aspirin in high-risk patients after PCI. N Engl J Med，2019， 381(21): 2032–2042.

HAHN J Y， SONG Y B， OH J H， et al. Effect of P2Y12 inhibitor monotherapy vs dual antiplatelet therapy on cardiovascular events in patients undergoing percutaneous coronary intervention: The SMART-CHOICE randomized clinical trial. JAMA，2019，321(24): 2428–2437.

GERSTEIN N S， ALBRECHTSEN C L， MERCADO N， et al. A Comprehensive update on Aspirin management during noncardiac surgery. Anesth Analg，2020，131(4): 1111–1123.

WAKSMAN R， KIRTANE A J， TORGUSON R， et al. Correlates and outcomes of late and very late drug-eluting stent thrombosis: results from DESERT (international drug-eluting stent event registry of thrombosis). JACC Cardiovasc Interv，2014，7(10): 1093–1102.

SPERTUS J A， KETTELKAMP R， VANCE C， et al. Prevalence, predictors, and outcomes of premature discontinuation of thienopyridine therapy after drug-eluting stent placement: Results from the PREMIER registry. Circulation，2006，113(24): 2803–2809.

MAURI L， KEREIAKES D， YEH R， et al. Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents. N Engl J Med，2014， 371(23): 2155–2166.

WANG W， LIU J， FANG J， et al. The optimal discontinuation of dual antiplatelet therapy in patients undergoing percutaneous coronary intervention with drug-eluting stents: A meta-analysis of randomized trials. Int J Cardiol，2017，235: 73–86.

PALMERINI T， BACCHI REGGIANI L， DELLA RIVA D， et al. Bleeding-related deaths in relation to the duration of dual-antiplatelet therapy after coronary stenting. J Am Coll Cardiol，2017，69(16): 2011.

KEDHI E， FABRIS E， VAN DER ENT M， et al. Six months versus 12 months dual antiplatelet therapy after drug-eluting stent implantation in ST-elevation myocardial infarction (DAPT-STEMI): Randomised, multicentre, non-inferiority trial. BMJ，2018，363: k3793.

HAHN J Y， SONG Y B， OH J H， et al. 6-month versus 12-month or longer dual antiplatelet therapy after percutaneous coronary intervention in patients with acute coronary syndrome (SMART-DATE): A randomised, open-label, non-inferiority trial. Lancet，2018，391(10127): 1274–1284.

VALGIMIGLI M， BUENO H， BYRNE R A， et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The task force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J，2018，39(3): 213–260.

OSCARSSON A， GUPTA A， FREDRIKSON M， et al. To continue or discontinue aspirin in the perioperative period: A randomized, controlled clinical trial. Br J Anaesth，2010，104(3): 305–312.

TOMŠIČ A， SCHOTBORGH M A， MANSHANDEN J S， et al. Coronary artery bypass grafting-related bleeding complications in patients treated with dual antiplatelet treatment. Eur J Cardiothorac Surg， 2016，50(5): 849–856.

GHERLI R， MARISCALCO G， DALÉN M， et al. Safety of preoperative use of ticagrelor with or without Aspirin compared with aspirin alone in patients with acute coronary syndromes undergoing coronary artery bypass grafting. JAMA Cardiol，2016，1(8): 921–928.

SAVONITTO S， D’URBANO M， CARACCIOLO M， et al. Urgent surgery in patients with a recently implanted coronary drug-eluting stent: A phase Ⅱ study of ‘bridging’ antiplatelet therapy with tirofiban during temporary withdrawal of clopidogrel. Br J Anaesth，2010，104(3): 285–291.

PICKETT A M， TAYLOR D A， ACKMAN M L. Prolonged infusion of eptifibatide as bridge therapy between bare-metal stent insertion and cardiovascular surgery: Case report and review of the literature. Pharmacotherapy， 2010， 30(4): 127e−133e[2021-01-05]. https://doi.org/10.1592/phco.30.4.420.

WESSLER J D， SALDANA F， GIUGLIANO R P. Bridging therapy after recent stent implantation: Case report and review of data. Cardiovasc Revasc Med，2012，13(1): 30–38.

ANGIOLILLO D J， FIRSTENBERG M S， PRICE M J， et al. Bridging antiplatelet therapy with cangrelor in patients undergoing cardiac surgery: A randomized controlled trial. JAMA，2012，307(3): 265–274.

STERN G， RIMSANS J， QAMAR A， et al. Contemporary parenteral antiplatelet bridging strategies: A single-centre real-world experience at a tertiary care centre. Euro Intervention，2018，14(3): e333–e335.

ANGIOLILLO D J， ROLLINI F， STOREY R F， et al. International expert consensus on switching platelet P2Y(12) receptor-inhibiting therapies. Circulation，2017，136(20): 1955–1975.

LORDKIPANIDZÉ M， DIODATI J G， PHARAND C. Possibility of a rebound phenomenon following antiplatelet therapy withdrawal: A look at the clinical and pharmacological evidence. Pharmacol Ther，2009， 123(2): 178–186.

SONG J W， SOH S， SHIM J K. Dual antiplatelet therapy and non-cardiac surgery: Evolving issues and anesthetic implications. Korean J Anesthesiol，2017，70(1): 13–21.

STONE G W， WITZENBICHLER B， WEISZ G， et al. Platelet reactivity and clinical outcomes after coronary artery implantation of drug-eluting stents (ADAPT-DES): A prospective multicentre registry study. Lancet， 2013，382(9892): 614–623.

MAHLA E， METZLER H， BORNEMANN-CIMENTI H， et al. Platelet inhibition and bleeding in patients undergoing non-cardiac surgery—The BIANCA observational study. Thromb Haemost，2018，118(5): 864–872.

BHATT D L， POLLACK C V， WEITZ J I， et al. Antibody-based ticagrelor reversal agent in healthy volunteers. N Engl J Med，2019， 380(19): 1825–1833.


Refbacks

  • There are currently no refbacks.