Perioperative myocardial infarction/injury after noncardiac surgery

Puelacher, Christian; Buse, Giovanna Lurati; Singeisen, Hélène; Dang, Minh Duc; Cuculi, Florim

doi:10.4414/smw.2015.14219

Cited by 21 publications

(27 citation statements)

References 46 publications

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“…The two different mechanisms cause two different types of PMI: type 1 (plaque rupture, STEMI) and type 2 (supply–demand imbalance of oxygen; NSTEMI). [13,14] In fact, differentiating between type 1 and type 2 PMI is difficult; it requires a set of diagnostic hints. In the present study, ECG changes were used to identify the differences (sometimes, NSTEMI can change to STEMI).…”

Section: Discussionmentioning

confidence: 99%

Perioperative acute myocardial infarction in patients after non-cardiac surgery in China

Zhou

Chen

et al. 2019

Medicine

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Section: Discussionmentioning

confidence: 99%

Perioperative acute myocardial infarction in patients after non-cardiac surgery in China

Zhou

Chen

et al. 2019

Medicine

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“…The pathophysiology of MINS is multifactorial and currently evolving. Both plaque rupture (Type-1 MI) and a mismatch between oxygen supply and demand (Type-2 MI) are explained as the causes of myocardial damage after non-cardiac surgeries in most studies (Helwani et al 2018, Puelacher et al 2015). Perioperative hyper/hypotension, hypoxia/hypercarbia, anaemia, surgical stress with sympathetic hyperactivity and inflammation are some of the aetiologies besides thrombosis that contribute to myocardial damage in MINS (Biccard & Rodseth 2010).…”

Section: Pathophysiology Of Minsmentioning

confidence: 99%

The role of high-sensitive troponin measurement as a biomarker during the postoperative period for the detection of myocardial injury after non-cardiac surgery

Iddagoda

2020

Journal of Perioperative Practice

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Myocardial injury after non-cardiac surgery is common and defined as myocardial ischaemia within 30 days after non-cardiac surgery. Diagnosis of myocardial injury after non-cardiac surgery is challenging as this could be clinically asymptomatic during the postoperative period due to many other factors. Role of high-sensitive cardiac troponin in diagnosing myocardial injury after non-cardiac surgery had been evaluated in several studies. Due to the fact that high-sensitive cardiac troponin remains positive for about two weeks in the body and is highly specific in diagnosing clinically silent myocardial injuries, it is recognised as the most useful biomarker in detecting myocardial injury after non-cardiac surgery. However, high-sensitive cardiac troponin is not well incorporated as a biomarker in current major perioperative guidelines or in clinical practice. The aim of this review is to discuss evidence and guidelines in this area in view of the use of high-sensitive cardiac troponin in early identification of myocardial injury after non-cardiac surgery.

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“…Various disorders contributing to thrombotic complications include atherosclerotic cardiovascular disease, defined as acute coronary syndrome, ischemic heart disease, peripheral arterial disease, atrial fibrillation, and multiple other www.painphysicianjournal.com ailments. These patients are widely prescribed with anticoagulants and antithrombotics in over 10% of the patients undergoing surgery or invasive procedures (255,256). However, a significant proportion of these patients may also undergo invasive procedures resulting in significant controversy.…”

Section: Risk/benefits Of Antithrombotic Therapymentioning

confidence: 99%

“…Estimates suggest that greater than two-thirds of sudden cardiac events (acute coronary syndrome or sudden cardiac death) and half of the postoperative myocardial infarctions follow initiation of an arterial plaque disruption and associated thrombosis (256)(257)(258)(259)(260)(261). Parallel clinical data on cerebrovascular events are not known; however, acute coronary syndrome is associated with pro-inflammatory and pro-thrombotic states, which involve elevated levels of fibrinogen, C-reactive protein, and plasminogen activator inhibitor (262).…”

Section: Risk/benefits Of Antithrombotic Therapymentioning

confidence: 99%

“…Parallel clinical data on cerebrovascular events are not known; however, acute coronary syndrome is associated with pro-inflammatory and pro-thrombotic states, which involve elevated levels of fibrinogen, C-reactive protein, and plasminogen activator inhibitor (262). In the postoperative period, endogenous catecholamines, increased platelet adhesiveness, and decreased fibrinolysis increase the risk of an acute coronary syndrome (256,260,263).…”

Section: Risk/benefits Of Antithrombotic Therapymentioning

confidence: 99%

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Responsible, Safe, and Effective Use of Antithrombotics and Anticoagulants in Patients Undergoing Interventional Techniques: American Society of Interventional Pain Physicians (ASIPP) Guidelines

Manchikanti

2019

Pain Phys

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Background: Interventional pain management involves diagnosis and treatment of chronic pain. This specialty utilizes minimally invasive procedures to target therapeutics to the central nervous system and the spinal column. A subset of patients encountered in interventional pain are medicated using anticoagulant or antithrombotic drugs to mitigate thrombosis risk. Since these drugs target the clotting system, bleeding risk is a consideration accompanying interventional procedures. Importantly, discontinuation of anticoagulant or antithrombotic drugs exposes underlying thrombosis risk, which can lead to significant morbidity and mortality especially in those with coronary artery or cerebrovascular disease. This review summarizes the literature and provides guidelines based on best evidence for patients receiving anti-clotting therapy during interventional pain procedures. Study Design: Best evidence synthesis. Objective: To provide a current and concise appraisal of the literature regarding an assessment of the bleeding risk during interventional techniques for patients taking anticoagulant and/or antithrombotic medications. Methods: A review of the available literature published on bleeding risk during interventional pain procedures, practice patterns and perioperative management of anticoagulant and antithrombotic therapy was conducted. Data sources included relevant literature identified through searches of EMBASE and PubMed from 1966 through August 2018 and manual searches of the bibliographies of known primary and review articles. Results: 1. There is good evidence for risk stratification by categorizing multiple interventional techniques into low-risk, moderate-risk, and high-risk. Also, their risk should be upgraded based on other risk factors. 2. There is good evidence for the risk of thromboembolic events in patients who interrupt antithrombotic therapy. 3. There is good evidence supporting discontinuation of low dose aspirin for high risk and moderate risk procedures for at least 3 days, and there is moderate evidence that these may be continued for low risk or some intermediate risk procedures.4. There is good evidence that discontinuation of anticoagulant therapy with warfarin, heparin, dabigatran (Pradaxa®), argatroban (Acova®), bivalirudin (Angiomax®), lepirudin (Refludan®), desirudin (Iprivask®), hirudin, apixaban (Eliquis®), rivaroxaban (Xarelto®), edoxaban (Savaysa®, Lixiana®), Betrixaban(Bevyxxa®), fondaparinux (Arixtra®) prior to interventional techniques with individual consideration of pharmacokinetics and pharmacodynamics of the drugs and individual risk factors increases safety. 5. There is good evidence that diagnosis of epidural hematoma is based on severe pain at the site of the injection, rapid neurological deterioration, and MRI with surgical decompression with progressive neurological dysfunction to avoid neurological sequelae. 6. There is good evidence that if thromboembolic risk is high, low molecular weight heparin bridge therapy can be instituted during cessation of the anticoagulant, and the low molecular weight heparin can be discontinued 24 hours before the pain procedure. 7. There is fair evidence that the risk of thromboembolic events is higher than that of epidural hematoma formation with the interruption of antiplatelet therapy preceding interventional techniques, though both risks are significant. 8. There is fair evidence that multiple variables including anatomic pathology with spinal stenosis and ankylosing spondylitis; high risk procedures and moderate risk procedures combined with anatomic risk factors; bleeding observed during the procedure, and multiple attempts during the procedures increase the risk for bleeding complications and epidural hematoma. 9. There is fair evidence that discontinuation of phosphodiesterase inhibitors is optional (dipyridamole [Persantine], cilostazol [Pletal]. However, there is also fair evidence to discontinue Aggrenox [dipyridamole plus aspirin]) 3 days prior to undergoing interventional techniques of moderate and high risk. 10. There is fair evidence to make shared decision making between the patient and the treating physicians with the treating physician and to consider all the appropriate risks associated with continuation or discontinuation of antithrombotic or anticoagulant therapy. 11. There is fair evidence that if thromboembolic risk is high antithrombotic therapy may be resumed 12 hours after the interventional procedure is performed. 12. There is limited evidence that discontinuation of antiplatelet therapy (clopidogrel [Plavix®], ticlopidine [Ticlid®], Ticagrelor [Brilinta®] and prasugrel [Effient®]) avoids complications of significant bleeding and epidural hematomas. 13. There is very limited evidence supporting the continuation or discontinuation of most NSAIDs, excluding aspirin, for 1 to 2 days and some 4 to 10 days, since these are utilized for pain management without cardiac or cerebral protective effect. Limitations: The continued paucity of the literature with discordant recommendations. Conclusion: Based on the survey of current literature, and published clinical guidelines, recommendations for patients presenting with ongoing antithrombotic therapy prior to interventional techniques are variable, and are based on comprehensive analysis of each patient and the risk-benefit analysis of intervention. Key words: Perioperative bleeding, bleeding risk, practice patterns, anticoagulant therapy, antithrombotic therapy, interventional techniques, safety precautions, pain

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Perioperative myocardial infarction/injury after noncardiac surgery

Cited by 21 publications

References 46 publications

Perioperative acute myocardial infarction in patients after non-cardiac surgery in China

Perioperative acute myocardial infarction in patients after non-cardiac surgery in China

The role of high-sensitive troponin measurement as a biomarker during the postoperative period for the detection of myocardial injury after non-cardiac surgery

Responsible, Safe, and Effective Use of Antithrombotics and Anticoagulants in Patients Undergoing Interventional Techniques: American Society of Interventional Pain Physicians (ASIPP) Guidelines

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