PROTOCOL FOR A PERIOPERATIVE APPROACH TO PATIENTS WITH CORONARY STENTS UNDERGOING NON-CARDIAC SURGERY
DOI:
https://doi.org/10.48729/pjctvs.56Abstract
Patients undergoing angioplasty and stent insertion require double prophylactic anti-aggregation or monotherapy. This is a challenging procedure with a high risk of morbidity and coronary mortality. The aim of this protocol is to provide guidelines for a presurgical approach to patients with a coronary stent who will be undergoing non-coronary surgery. This protocol highlights potential complications that may occur, namely those related with the cardiac stent and the evaluation of cardiac risk, and notes the thrombotic and hemorrhagic risks associated with the surgical procedure and the decision algorithms for both elective surgery and urgent surgery involving the suspension and re-introduction of antiplatelet therapy. Our main goal is to outline an optimized approach to these cases in order to improve cardiac outcomes and to minimize the risk of complications.
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References
Marco Valgimigli, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. European Heart Journal (2018) 39, 213–254
Kaplan Joel, et al. Essentials of Cardiac Anesthesia for Noncardiaca Surgery. Copryright© 2019 by Elsevier, Inc.
Cutlip DE et al. Clinical end points in coronary stent trials. Circulation. 2007; 115:2344-2351
Franz-Josef Neumann, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. European Heart Journal (2019) 40, 87–165
Fonseca C, Alves J, Araújo F. (2014) Manuseio peri-operatório dos doentes medicados com anticoagulantes e antiagregantes plaquetários: resultado da 3a reunião de consenso da sociedade portuguesa de anestesiologia. Conselhos da Sociedade Portuguesa de Anestesiologia.
Christopher P. Childers, et al. Perioperative management of antiplatelet therapy in patients undergoing non-cardiac surgery following coronary stent placement: a systematic review (2018).7:4
CutlipD, Windecker S, L Cohn S, et al. Noncardiac surgery after percutaneous coronary intervention. UpToDate Inc. (acedido em Março de 2019).
Levine GN, Bates ER, Bittl JA, et al. 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease. Journal of the American College of Cardiology, Volume 68, Issue 10, September
Song, J. W., Soh, S., & Shim, J. K. (2017). Dual antiplatelet therapy and non-cardiac surgery: evolving issues and anesthetic implications. Korean journal of anesthesiology, 70(1), 13–21. doi:10.4097/kjae.2017.70.1.13.
Capodanno D, Tamburino C. Bridging antiplatelet therapy in patients requiring cardiac and non-cardiac surgery: From bench to bedside. J Cardiovasc Transl Res. 2014. doi:10.1007/s12265-013-9517-5
Steven Coutre, MD, et al. Congenital and acquired disorders of platelet function (2018). UpToDate Inc.
