Cardiac Risk of Noncardiac Surgery after Percutaneous Coronary Intervention with Drug-eluting Stents

Rabbitts, Jennifer A.; Nuttall, Gregory A.; Brown, Michael J.; Hanson, Andrew C.; Oliver, William C.; Holmes, David R.; Rihal, Charanjit S.

doi:10.1097/aln.0b013e318186de1c

Cited by 193 publications

(120 citation statements)

References 26 publications

(18 reference statements)

Supporting

Mentioning

103

Contrasting

Unclassified

Order By: Relevance

“…According to the ACC guidelines, orthopedic surgery is considered to be an intermediate risk procedure. In our review, emergent NCS regardless of type was itself associated with an increased risk for MACEs [10,11,16,18]. In the era of damage control orthopedics as well as the uniformity of findings suggesting emergency surgery as a risk factor for stent thrombosis, emergent surgery may not always be best for the patient.…”

Section: Discussionmentioning

confidence: 95%

“…Despite the dilemma, there has yet to be one article in the literature which specifically addresses the orthopedic patient population. All of the studies published to date address all surgical procedures as "noncardiac surgery" which includes all surgical procedures from low to high risk [10,11,17]. Therefore, it is difficult to interpret the findings of the literature and translate them into the orthopedic setting without some reservations.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of bleeding was 5% versus 4% versus 5.4% when antiplatelet agent was used within 7 days versus 4% if stopped more than 7 days prior to surgery or 5.4% if there was no use within 30 days of the time of surgery. An additional study [10] reported the experience in 520 patients who had PCI with DES who discontinued dual antiplatelet therapy at varying time points before NCS. There was no difference seen in adverse bleeding events or transfusion requirements between discontinuation of thienopyridine use within 7 days, 7-30 days, or >30 days prior to surgery.…”

Section: Bleeding Risk On Dual Antiplatelet Therapymentioning

confidence: 99%

“…Rabbitts et al from the Mayo clinic performed a retrospective review of 520 patients undergoing noncardiac surgery (NCS) within 2 years from DES placement and assessed their risk of major adverse cardiac events (MACEs) based on time between PCI and NCS [10]. The time points were stratified into 3-month periods based on time after PCI (i.e., 0-90, 91-180, 181-365, 366-730 days).…”

Section: Risk Of Thrombosis In Noncardiac Surgerymentioning

confidence: 99%

See 3 more Smart Citations

The Management of Patients on Dual Antiplatelet Therapy Undergoing Orthopedic Surgery

Kim

Levin

2010

HSS Jrnl

View full text Add to dashboard Cite

Cardiovascular disease is prevalent in patients undergoing orthopedic surgery. Many patients who have undergone previous percutaneous coronary intervention (PCI) with stenting are on dual antiplatelet therapy in order to minimize the risk of stent thrombosis. The optimal management of these patients in the perioperative setting remains unclear. We aim to provide information about the management of patients who have undergone a PCI with stents who are subsequently indicated for an orthopedic procedure. We will review the concerns from a cardiologist's and orthopedic surgeon's perspective in regards to the management of these patients in the perioperative setting. In addition,

show abstract

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Bleeding Risk On Dual Antiplatelet Therapymentioning

confidence: 99%

Section: Risk Of Thrombosis In Noncardiac Surgerymentioning

confidence: 99%

See 2 more Smart Citations

The Management of Patients on Dual Antiplatelet Therapy Undergoing Orthopedic Surgery

Kim

Levin

2010

HSS Jrnl

View full text Add to dashboard Cite

show abstract

“…After DES, the rate of adverse cardiac events is more continuous (5.9% up to 12 months) and drops to 3.3% beyond 1 year, but the mortality is high (average 35%) [17].…”

Section: Antiplatelet Agents and Coronary Revascularisationmentioning

confidence: 99%

Urological Surgery and Antiplatelet Drugs After Cardiac and Cerebrovascular Accidents

Eberli

Chassot²,

Sulser

et al. 2010

Journal of Urology

View full text Add to dashboard Cite

Context: The perioperative management of patients under dual antiplatelet therapy after myocardial infarction, cerebrovascular event or coronary stent implantation represents an increasingly frequent issue for urologists and anaesthesiologists.Objective: To assess the current scientific evidence and propose strategies concerning the management of urologic patients under antiplatelet therapy. A Medline & PubMed search was conducted for articles related to antiplatelet therapy after myocardial infarction, coronary stents and cerebrovascular events, and to the management of aspirin and/or clopidogrel in the context of surgery.Results: Early discontinuation of antiplatelet therapy in secondary prevention is associated with a high risk of coronary thrombosis, further increased by the hypercoagulable state induced by surgery. Aspirin has recently been recommended to be a lifelong therapy. Clopidogrel is mandatory for 6 weeks after myocardial infarction and bare-metal stents, and for 12 months after drug-eluting stents. Surgery must be postponed beyond these waiting periods, or be performed under dual antiplatelet therapy, because withdrawal therapy increases 5-10 times the risk of postoperative myocardial infarction, stent thrombosis or death. The shorter the waiting periods between revascularisation and surgery, the higher is the risk of adverse cardiac events. The risk of surgical haemorrhage is increased approximately 20% by aspirin and 50% by clopidogrel. Conclusions:The present review of the literature demonstrates that the risk of coronary thrombosis when antiplatelet agents are withdrawn before surgery is generally higher than the risk of surgical haemorrhage when antiplatelet agents are upheld. However, this issue has not yet been sufficiently evaluated in urologic patients and in many instances during urologic surgery the risk of bleeding might be exceedingly dangerous. In this problematic situation, a thorough dialogue between surgeon, cardiologist and anaesthesiologist is essential to determine all risk factors and to define the best possible strategy for each individual patient.

show abstract

Risk of Major Adverse Cardiac Events Following Noncardiac Surgery in Patients With Coronary Stents

Hawn

Graham

Richman

et al. 2013

JAMA

289

136

View full text Add to dashboard Cite

Cardiac Risk of Noncardiac Surgery after Percutaneous Coronary Intervention with Drug-eluting Stents

Abstract: The risk of MACEs with NCS after DES placement was not significantly associated with time from stenting to surgery, but observed rates of MACEs were lowest after 1 yr.

Cited by 193 publications

References 26 publications

The Management of Patients on Dual Antiplatelet Therapy Undergoing Orthopedic Surgery

The Management of Patients on Dual Antiplatelet Therapy Undergoing Orthopedic Surgery

Urological Surgery and Antiplatelet Drugs After Cardiac and Cerebrovascular Accidents

Risk of Major Adverse Cardiac Events Following Noncardiac Surgery in Patients With Coronary Stents

Contact Info

Product

Resources

About