Kiran Usha, Makhija Neeti
Prof and Head, Department of Cardiac Anaesthesia, Cardiac Neuro Center, All India Institute of Medical Sciences, New Delhi.
Indian J Anaesth. 2009 Oct;53(5):582-91.
Anaesthesiologists are increasingly confronted with patients who had a recent coronary artery stent implantation and are on dual anti-platelet medication. Non cardiac surgery and most invasive procedures increase the risk of stent thrombosis especially when procedure is performed early after stent implantation. Anaesthesiologist faces the dilemma of stopping the antiplatelet therapy before surgery to avoid bleeding versus perioperative stent thrombosis. Individualized approach should be adopted with following precautions. i) In a surgical patient with a history of percutaneous coronary intervention (PCI) and coronary stent, determine the date of the procedure, the kind of the stent inserted and the possibility of complications during the procedure. ii) Consider all patents with a recent stent implantation (e.g. less than three months for bare metal stents and less than one year for brachytherapy or drug eluting stents as high risk and consult an interventional cardiologist. iii) Any decision to postpone surgery, continue, modify or discontinue antiplatelet regimes must involve the cardiologist, anaesthesiologist, surgeon, haematologist and the intensivist to balance the risk and benefit of each decision.
麻醉医生越来越多地面临着近期植入冠状动脉支架且正在接受双重抗血小板治疗的患者。非心脏手术和大多数侵入性操作会增加支架血栓形成的风险，尤其是在支架植入后早期进行手术时。麻醉医生面临着在手术前停止抗血小板治疗以避免出血与围手术期支架血栓形成之间的两难境地。应采取个体化方法并遵循以下预防措施。i）对于有经皮冠状动脉介入治疗（PCI）和冠状动脉支架植入史的手术患者，确定手术日期、植入的支架类型以及手术期间发生并发症的可能性。ii）将所有近期植入支架的患者（例如，裸金属支架植入后少于三个月，近距离放射治疗或药物洗脱支架植入后少于一年）视为高风险患者，并咨询介入心脏病专家。iii）任何推迟手术、继续、修改或停止抗血小板治疗方案的决定都必须由心脏病专家、麻醉医生、外科医生、血液科医生和重症监护医生共同参与，以平衡每个决定的风险和益处。
