2014 ESC/ESA Guidelines on Non-cardiac Surgery: Cardiovascular Assessment and Management

Kristensen, Steen Dalby; Knuuti, Juhani; Saraste, Antti; Anker, Stefan D.; Bøtker, Hans Erik; Hert, Stefan De; Ford, Ian; González-Juanàtey, José Ramón; Görenek, Bülent; Heyndrickx, Guy R.; Hoeft, Andreas; Huber, Kurt; Iung, Bernard; Kjeldsen, Keld; Longrois, Dan; Lüscher, Thomas F.; Piérard, Luc; Pocock, Stuart J.; Price, Susanna; Roffi, Marco; Sirnes, Per Anton; Sousa‐Uva, Miguel; Voudris, Vasilis; Funck‐Brentano, Christian

doi:10.1016/j.rec.2014.11.001

Cited by 9 publications

(19 citation statements)

References 187 publications

(254 reference statements)

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“…W przypadku operacji niekardiochirurgicznej, która nie może być przełożo-na na później, akceptowalny minimalny okres DAPT wynosi, odpowiednio, minimum 1 i 3 miesiące w przypadku stentów metalowych (BMS) i stentów DES nowej generacji [179]. W tej sytuacji należy przeprowadzać zabiegi operacyjne w szpitalach z ciągłym dostępem do pracowni hemodynamicznej w celu natychmiastowego leczenia pacjenta w razie wystą-pienia okołooperacyjnego MI [179]. Jeśli przerwanie DAPT okazuje się konieczne z powodu pilnego zabiegu wysokiego ryzyka (np.…”

Section: Przedwczesne Zakończenie Doustnego Leczenia Przeciwpłytkowegounclassified

“…U pacjentów poddawanych operacji niekardiochirurgicznej w trybie elektywnym należy zaprzestać stosowania tikagreloru i klopidogrelu 5 dni przed operacją. Przerwa w podawaniu leku powinna być wydłużo-na w przypadku prasugrelu do 7 dni, chyba że pacjent jest obciążony wysokim ryzykiem zakrzepicy w stencie [179]. W opisanej wyżej sytuacji konieczne jest podjęcie decyzji przez wielodyscyplinarny zespół w celu określenia najlepszej strategii postępowania.…”

Section: Przedwczesne Zakończenie Doustnego Leczenia Przeciwpłytkowegounclassified

See 1 more Smart Citation

2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

Roffi¹,

Patrono²,

Collet³

et al. 2015

Kardiol Pol

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162

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Section: Przedwczesne Zakończenie Doustnego Leczenia Przeciwpłytkowegounclassified

2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

Roffi¹,

Patrono²,

Collet³

et al. 2015

Kardiol Pol

Self Cite

191

162

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“…Based on their findings, the authors conclude that surgery following DES-PCI may be safely considered sooner than is recommended in current guidelines (5,6). Before embracing this change, it should be highlighted that the majority of surgical procedures undertaken in the study were classified as low risk (>70%) and the number of clinical events observed beyond one month was low, limiting the statistical power of the study.…”

Section: "Dear Colleague This 68 Year Old Diabetic Lady Recently Undmentioning

confidence: 97%

“…Within this cohort, retrospective observational studies report an overall incidence of peri-operative death or major adverse cardiac events of 2-9%, with the greatest risk when surgery is performed early after stent implantation (1)(2)(3)(4). Based on these data, the American College of Cardiology and American Heart Association focused update on duration of dual antiplatelet therapy in patients with coronary artery disease (5) recommends that non-cardiac surgery should be delayed for at least three (class IIb recommendation), but ideally for 6 months (class IIa recommendation), while the most recent European Society of Cardiology guidelines recommend delaying surgery for 6 months following DES implantation (6).…”

Section: "Dear Colleague This 68 Year Old Diabetic Lady Recently Undmentioning

confidence: 99%

Non-cardiac surgery following drug-eluting coronary stent implantation—a question of timing?

2017

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"Dear colleague, this 68 year old diabetic lady recently underwent percutaneous coronary intervention with drug eluting stents. Unfortunately, she now requires hip replacement surgery. I would be grateful for your advice regarding the optimal timing of surgery …"This clinical scenario will be familiar to many involved in the management of patients undergoing non-cardiac surgery. Observational data indicate that between 5% and 35% of patients receiving a drug eluting stent (DES) undergo non-cardiac surgery within 1-2 years of their index percutaneous coronary intervention (PCI). Within this cohort, retrospective observational studies report an overall incidence of peri-operative death or major adverse cardiac events of 2-9%, with the greatest risk when surgery is performed early after stent implantation (1-4). Based on these data, the American College of Cardiology and American Heart Association focused update on duration of dual antiplatelet therapy in patients with coronary artery disease (5) recommends that non-cardiac surgery should be delayed for at least three (class IIb recommendation), but ideally for 6 months (class IIa recommendation), while the most recent European Society of Cardiology guidelines recommend delaying surgery for 6 months following DES implantation (6).Besides their retrospective observational design, major limitations of previous studies have been the lack of a meaningful comparator or control population and the absence of detailed data on peri-operative antiplatelet use. Without these, it remains unclear to what degree the observed rate of peri-operative cardiac events is attributable to the presence of a DES, existing ischaemic heart disease, premature interruption of dual antiplatelet therapy, or surgical factors such as the urgency, type or magnitude of surgery undertaken. A recent study published in the Journal of the American College of Cardiology goes some way towards addressing these limitations and provides further insight into the relationship between the timing of surgery and peri-operative cardiac risk.Egholm and colleagues undertook a retrospective data linkage study using the Western Denmark Heart and Danish National Patient Registries between 2005 and 2012 to identify 4,303 patients who underwent surgery within 12 months of DES implantation, and 20,032 patients without known ischaemic heart disease who underwent similar surgical procedures (7). Clinical outcomes at 30 days (myocardial infarction, cardiac death and all cause mortality) for each DES-PCI patient were compared with up to five control patients matched for age, sex and type of operation. Within the PCI cohort, use of first generation DES was high (60%) with just over half of the patients (56%) undergoing stent implantation for an acute coronary syndrome.Consistent with previous studies (2,4), surgery performed within 1 month of DES implantation, emergency surgery, Editorial

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“…Экспер-ты Американского общества торакальных хи-рургов (2012), а также Европейского общества кардиологов и Европейского общества анесте-зиологов (2014) считают обоснованным тес-тирование тромбоцитов больным, принимаю-щим ДАТ, которым необходимо оперативное (в том числе некардиальное) вмешательство [21,22].…”

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Individual Approach to Patients With Indication for Antiplatelet Therapy. What to Rely on in Choosing the Therapy?

Lomakin¹,

Сумароков²,

Доценко³

et al. 2017

Aterotromboz

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Н акопленный опыт применения антиаг-регантной терапии у больных ИБС поз-волил сформулировать некоторые крае-угольные положения лечения препаратами дан-ного ряда. Во-первых, антиагреганты, безуслов-но, нужны и полезны при лечении ИБС.Прежде всего, это четко видно у больных ОКС и после имплантации коронарного стен-та, где их широкое внедрение позволило зна-чительно улучшить исходы болезни. Во-вто-рых, назначая антиагрегант или комбинацию препаратов этого класса, врач должен предви-деть возможности как чрезмерной выражен-ности антитромботического эффекта, так и недостаточной степени его эффекта, несмотря на регулярный прием и адекватные дозы пре-парата; последнее явление получило название «резистентность к антиагреганту». Оба откло-нения могут привести к серьезным клиничес-ким осложнениям -к кровотечению или, на-оборот, к тромбозу. В недостаточном эффекте препарата могут быть виноваты и генетически обусловленные нарушения метаболизма от-дельных препаратов на уровне цитохромов

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2014 ESC/ESA Guidelines on Non-cardiac Surgery: Cardiovascular Assessment and Management

Cited by 9 publications

References 187 publications

2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

Non-cardiac surgery following drug-eluting coronary stent implantation—a question of timing?

Individual Approach to Patients With Indication for Antiplatelet Therapy. What to Rely on in Choosing the Therapy?

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