Departments of Urology, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
BJU Int. 2012 Aug;110(4):480-4. doi: 10.1111/j.1464-410X.2011.10821.x. Epub 2011 Dec 22.
What's known on the subject? and What does the study add? Withdrawal of dual antiplatelet therapy before the recommended, 12 months for drug-eluting stents and 1 month for bare-metal stents increases the rate of major adverse coronary events and mortality. However, in those undergoing surgery the risk of bleeding is increased substantially for those on antiplatelet agents. Successful management in patients with coronary stents who must undergo elective or non-elective urological surgery should be a multidisciplinary decision. This article reviews the literature and recommends a protocol for clinical management of patients undergoing urological procedures after coronary stent placement. To review the literature on coronary stents and genitourinary surgery and provide a protocol for perioperative. The keywords, 'elective surgery', 'aspirin', 'clopidogrel', 'guidelines for percutaneous coronary intervention', and 'antiplatelet therapy after coronary stent placement' were used to search PubMed for any relevant articles relating to coronary stents. Recommendations were made based on the whether the procedures patients were exposed to placed them at low-, moderate- or high-bleeding risk based on the extent of the procedure. All elective procedures should be delayed for 1 month after bare-metal stent placement and 1 year after drug-eluting stent placement. In patients classified as low risk (endoscopy and laser prostatectomy), aspirin should be continued throughout the perioperative period and dual antiplatelet therapy should continue 24-48 h postoperatively, if there is no concern for active bleeding. In those classified as moderate risk (scrotal procedures, transurethral resection of bladder tumours, transurethral resection of the prostate, urinary sphincter placement) dual antiplatelet therapy should be discontinued 5-7 days before the procedure and continued within 7 days after procedure, if there is no concern for active bleeding, in consultation with cardiology. In high-risk procedures (cystectomy, nephrectomy, prostatectomy, penile prosthesis placement) dual antiplatelet therapy should be discontinued 10 days before the procedure and continued postoperatively within 7-10 days of the procedure, when there is no longer a concern for active bleeding with the assistance of a cardiologist. Coronary artery disease is becoming more prominent in our society, increasing the use of coronary stents and antiplatelet agents. With the proposed protocol, it is safe to proceed with surgical intervention in those that have adequate stent endothelialisation.
在推荐的药物洗脱支架 12 个月和裸金属支架 1 个月之前停用双联抗血小板治疗会增加主要不良冠状动脉事件和死亡率。然而，对于接受抗血小板治疗的患者，手术中的出血风险会大大增加。对于必须接受择期或非择期泌尿科手术的冠状动脉支架置入患者，成功的管理应该是多学科决策。本文回顾了文献，并为接受冠状动脉支架置入后接受泌尿科手术的患者的临床管理推荐了一个方案。
检索了关于冠状动脉支架和泌尿生殖系统手术的文献，并提供了围手术期的方案。使用关键词“择期手术”、“阿司匹林”、“氯吡格雷”、“经皮冠状动脉介入治疗指南”和“冠状动脉支架置入后抗血小板治疗”，在 PubMed 上搜索了与冠状动脉支架相关的任何相关文章。根据患者所接受的手术是否使他们处于低、中或高出血风险，基于手术的范围，提出了建议。
所有择期手术应在裸金属支架放置后 1 个月和药物洗脱支架放置后 1 年内延迟。对于低危患者（内窥镜和激光前列腺切除术），如果没有活动性出血的顾虑，应在围手术期全程继续使用阿司匹林，并在术后 24-48 小时继续双联抗血小板治疗。对于中危患者（阴囊手术、经尿道膀胱肿瘤切除术、经尿道前列腺切除术、尿括约肌置入术），如果没有活动性出血的顾虑，应在术前 5-7 天停用双联抗血小板治疗，并在术后 7 天内继续使用，与心脏病专家协商。对于高危患者（膀胱癌切除术、肾切除术、前列腺切除术、阴茎假体置入术），如果在心脏病专家的协助下不再有活动性出血的顾虑，应在术前 10 天停用双联抗血小板治疗，并在术后 7-10 天内继续使用。
随着建议方案的提出，对于支架内皮化充分的患者，进行手术干预是安全的。
