Appropriate waiting time for noncardiac surgery following coronary stent insertion: views of Canadian anethesiologists

Patterson, Lindsey; Hunter, Duncan; Mann, Andrea

doi:10.1007/bf03016295

Cited by 12 publications

(6 citation statements)

References 1 publication

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“…The need to delay elective surgery whenever possible after stent implantation cannot be overemphasized. In a survey of anesthesiologists, 63% were not aware of recommendations about the appropriate length of time between stent placement and a subsequent surgical procedure, and one-third recommended no delay or a delay of only 1 to 2 weeks, which is insufficient for BMS, and even more so for DES (40).…”

Section: Stop Clopidogrel and Restart It After Surgerymentioning

confidence: 97%

Perioperative Management of Patients With Coronary Stents

Brilakis¹,

Banerjee²,

Berger

2007

Journal of the American College of Cardiology

184

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Perioperative coronary stent thrombosis is a catastrophic complication that can occur in patients receiving both bare-metal and drug-eluting stents. Noncardiac surgery appears to increase the risk that recently-placed stents thrombose, especially when surgery is performed early after stenting, and particularly if dual antiplatelet therapy is discontinued. We reviewed the existing data about the frequency of stent thrombosis after noncardiac surgery and explored the impact of delay from surgery and discontinuation of antiplatelet therapy. We also reviewed the data about the impact of preoperative revascularization in patients known to require noncardiac surgery. Based on these published data, we offer recommendations that can be used to guide the treatment of patients who require noncardiac surgery after having received a stent.

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Section: Stop Clopidogrel and Restart It After Surgerymentioning

confidence: 97%

Perioperative Management of Patients With Coronary Stents

Brilakis¹,

Banerjee²,

Berger

2007

Journal of the American College of Cardiology

184

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“…We review the treatment protocols that are still applicable to the different devices currently in use in clinical practice and identify safe and appropriate plans for dealing with emergency and elective surgery for these patients [16,[18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Coronary artery stents and surgery; the basis of sound perioperative management

Bolsin¹,

Hiew²,

Birdsey³

et al. 2013

Health

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The introduction of drug-eluting stents (DES) to interventional cardiology heralded a limited time of increased anaesthetic and surgical complications in patients implanted with these devices. The horns of the dilemma, in the anaesthetic and surgical management of patients in the first 3 -6 months after the 1 st generation DES insertion, were between the risk of bleeding from continued clopidogrel treatment and the risk of instent thrombosis and myocardial infarction following discontinuation of dual antiplatelet therapy, clopidogrel and aspirin. Initial accounts of early catastrophic cardiac and haemorrhagic complications, at the time of elective or emergency surgery, following DES insertion, were followed by equally worrying reports of in-stent thrombosis many months after DES insertion. Initial recommendations for the conduct of safe operations were propagated in the literature before formal guidelines were produced. This article summarises the issues identified in the development of interventional cardiology particularly DES and the requirement for ongoing antiplatelet therapy. The article reviews the treatment protocols that are still applicable for the different devices that have been deployed in clinical practice.

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“…15 Results from a survey of clinicians indicated that 63% of participants were not aware of the ACC/AHA guidelinerecommended delay between stent placement and subsequent surgical procedure, and approximately 30% of survey participants were found to recommend no delay or a delay of 1 to 2 weeks only. 16 This lack of awareness of the guideline recommendations in addition to poor or absent communication with patients' cardiologists while managing patients who may need to undergo a planned or an unplanned surgery increases the risk of cardiovascular or bleeding event rates in patients with ACS. Additionally, increased bleeding in patients, potentially because of inappropriate use of proton pump inhibitors (PPIs), has been shown to lead to premature discontinuation of antiplatelet therapy.…”

mentioning

confidence: 98%

Are Continuing Medical Education Activities Effective in Improving the Competence and Performance of Clinicians?

Sampath¹,

Dietze²,

Tóth

et al. 2012

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine

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An estimated 610,000 new cases of myocardial infarction (MI) and 325,000 recurrent MIs will occur this year in the United States, accounting for 1 MI every 34 seconds. Despite the advances in acute coronary syndrome management, recurrent events and the mortality associated with acute coronary syndromes are also high. There is clear evidence that knowledge, competence, and performance gaps exist among clinicians, contributing to the lack of adherence, premature discontinuation, and the increased risk of cardiovascular events in patients. As primary care clinicians manage these patients during the chronic phase of treatment, educational activities addressing identified gaps were developed and presented nationally. Outcome measurements using pre-, post-, and follow-up surveys showed that knowledge, confidence, competence, and performance significantly improved resulting in better patient outcomes as reported by activity participants. Thus, continuing medical education activities developed with the clear goal of changing clinician behavior can be effective in improving outcomes among patients with coronary artery disease.

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Appropriate waiting time for noncardiac surgery following coronary stent insertion: views of Canadian anethesiologists

Cited by 12 publications

References 1 publication

Perioperative Management of Patients With Coronary Stents

Perioperative Management of Patients With Coronary Stents

Coronary artery stents and surgery; the basis of sound perioperative management

Are Continuing Medical Education Activities Effective in Improving the Competence and Performance of Clinicians?

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