Prevention of the renarrowing of coronary arteries using drug-eluting stents in the perioperative period: an update

Juan V Llau¹, Raquel Ferrandis¹, Pilar Sierra², Aurelio Gómez-Luque^3
1Department of Anaesthesiology and Critical Care Medicine, Hospital Clínic Universitari, València, Spain; ²Department of Anaesthesiology, Fundació Puigvert, Barcelona, Spain; ³Department of Anaesthesiology and Critical Care Medicine, Hospital Clínico Universitario, Málaga, Spain

Abstract: The management of patients scheduled for surgery with a coronary stent, and receiving 1 or more antiplatelet drugs, has many controversies. The premature discontinuation of antiplatelet drugs substantially increases the risk of stent thrombosis (ST), myocardial infarction, and cardiac death, and surgery under an altered platelet function could also lead to an increased risk of bleeding in the perioperative period. Because of the conflict in the recommendations, this article reviews the current antiplatelet protocols after positioning a coronary stent, the evidence of increased risk of ST associated with the withdrawal of antiplatelet drugs and increased bleeding risk associated with its maintenance, the different perioperative antiplatelet protocols when patients are scheduled for surgery or need an urgent operation, and the therapeutic options if excessive bleeding occurs.

Keywords: stent thrombosis, antiplatelet agents, aspirin, clopidogrel, surgical bleeding, perioperative management