Use of Antiplatelet Therapy/DAPT for Post-PCI Patients Undergoing Noncardiac Surgery

Abstract Dual antiplatelet therapy (DAPT) is prescribed to millions of patients worldwide following coronary stenting. DAPT is indicated to lower the risk of ischemic events, such as myocardial infarction, including stent thrombosis, ischemic stroke, or death from cardiovascular causes. A significan...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2017-04, Vol.69 (14), p.1861-1870
Main Authors: Banerjee, Subhash, MD, Angiolillo, Dominick J., MD, PhD, Boden, William E., MD, Murphy, Joseph G., MD, Khalili, Houman, MD, Hasan, Ahmed A., MD, PhD, Harrington, Robert A., MD, Rao, Sunil V., MD
Format: Article
Language:English
Subjects:
Aged
Antiplatelet therapy
aspirin
Bleeding
Cardiac arrhythmia
Cardiology
Cardiovascular
Cardiovascular disease
Cerebral infarction
Clinical decision making
Clinical trials
Complications
coronary balloon angioplasty
Decision making
drug-eluting stents
Female
Health risk assessment
Humans
Implants
Internal Medicine
Interruption
Intervention
Ischemia
Male
Medical research
Middle Aged
Myocardial infarction
Patients
Percutaneous Coronary Intervention
Perioperative Care
Platelet Aggregation Inhibitors - administration & dosage
risk assessment
Stents
Stroke
Surgery
Surgical implants
Therapy
Thromboembolism
Thrombosis
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Summary:Abstract Dual antiplatelet therapy (DAPT) is prescribed to millions of patients worldwide following coronary stenting. DAPT is indicated to lower the risk of ischemic events, such as myocardial infarction, including stent thrombosis, ischemic stroke, or death from cardiovascular causes. A significant number of these patients undergo noncardiac surgery and may require DAPT interruption. This poses a significant clinical dilemma because DAPT interruption exposes patients to the potential risk of stent thrombosis, perioperative myocardial infarction, or both. Conversely, continuing DAPT may be associated with excess bleeding complications. Observational data in this area are conflicting, and there are no randomized clinical trials to guide practitioner decision making. On the basis of predominantly consensus recommendations, various strategies for managing DAPT during the perioperative period have been proposed. This review presents 3 commonly encountered clinical scenarios that lead into an evidence-based discussion of practical strategies for managing perioperative antiplatelet therapy in patients following percutaneous coronary intervention.
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2017.02.012