Focused Clinical Review: Periprocedural Management of Antiplatelet Therapy in Patients with Coronary Stents

Coronary Artery Bypass Surgery Provides Long-Term Results Superior to Percutaneous Coronary Intervention

“…The continuation of aspirin alone during the perioperative period in high-risk patients with drug-eluting stents should be considered [24,25]. A recent review by Bell et al provides a suggested algorithm for management of antiplatelet therapy in the peri-operative period [26]. and over 20 years of follow-up data [27].…”

“…Summary of 15 Randomised Controlled Trials of Percutaneous Coronary Intervention Versus Coronary Artery BypassGrafting in Multivessel Disease[26]. Synergy Between PCI With Taxus and Cardiac Surgery) trial were released in 2011[40].…”

Clopidogrel-Associated Thrombotic Thrombocytopenic Purpura following Endovascular Treatment of Spontaneous Carotid Artery Dissection

“…Following carotid and coronary artery stenting, thienopyridines and aspirin are prescribed to reduce the rate of stent thrombosis and consequent major complications. 7 8 9 All three thienopyridines (ticlopidine, clopidogrel, and prasugrel) have been linked to TTP. Ticlopidine has the highest reported incidence of TTP at 1 case per 1,600 to 5,000 treated patients.…”

Commentary on “Initial Experience with Aspirin Use During Robotic Radical Prostatectomy”

“…3 With a lack of randomized controlled data to guide the ideal duration of antiplatelet therapy following coronary stent placement, many medical physicians and cardiologists are recommending continuous antiplatelet therapy indefinitely and during the perioperative period. 4 The risk of bleeding with pelvic oncologic surgery is substantial, and in the case of radical prostatectomy, a large pelvic hematoma can affect surgical recovery, prolong catheter time, alter continence outcomes, and return of potency. The benefits of robotic prostatectomy (RAP) with regards to decreased blood loss compared with open surgery have been well reported.…”

“…It is clear that patients with previous stent thrombosis, left main artery stenting, multivessel stenting, and those with a stent in their only remaining graft should stay on antiplatelet therapy. 4 Other than those patients listed above, blanket statements that all previous coronary stent patients should continue antiplatelet therapy may rob someone of the potential benefits of RAP and may be asking the urologic surgeon to take unnecessary risk when it is not needed. On the flip side, better risk stratification may help aid in avoiding surgery completely in those at very high risk.…”