Franchi Francesco, Rollini Fabiana, Angiolillo Dominick J
University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA.
Curr Opin Cardiol. 2014 Nov;29(6):553-63. doi: 10.1097/HCO.0000000000000104.
To provide an updated overview on the management of antiplatelet therapy in patients with coronary stents undergoing cardiac and noncardiac surgery.
Surgical procedures are frequently performed in patients with coronary stents and are associated with an increased risk of ischemic and bleeding complications in the perioperative period. Given the lack of well-designed prospective randomized trials, guidelines recommendations are currently derived from observational studies and expert consensus. Defining the optimal balance between the risk of thrombotic events following discontinuation of antiplatelet therapy and the risk of hemorrhagic complications of having a surgical procedure while on antiplatelet therapy is pivotal. Elective surgery should be postponed for at least 4 weeks after bare metal stent implantation and 6-12 months after drug-eluting stent. If this is not possible, aspirin should be continued in the perioperative period, although the management of P2Y₁₂ inhibitors should be individualized according to the individual patient and type of surgery.
In the absence of well-defined recommendations deriving from prospective randomized clinical trials, the perioperative management of antiplatelet therapy should be based on the balance between the specific thrombotic and hemorrhagic risks that characterize each patient and each surgical procedure.
提供关于接受心脏和非心脏手术的冠状动脉支架置入患者抗血小板治疗管理的最新概述。
冠状动脉支架置入患者经常接受外科手术，且围手术期缺血和出血并发症风险增加。鉴于缺乏精心设计的前瞻性随机试验，目前指南建议源自观察性研究和专家共识。确定停用抗血小板治疗后血栓形成事件风险与接受抗血小板治疗时进行外科手术的出血并发症风险之间的最佳平衡至关重要。择期手术应在裸金属支架置入后至少推迟4周，在药物洗脱支架置入后推迟6至12个月。如果无法做到这一点，围手术期应继续使用阿司匹林，尽管P2Y₁₂抑制剂的管理应根据个体患者和手术类型个体化。
在缺乏来自前瞻性随机临床试验的明确建议的情况下，抗血小板治疗的围手术期管理应基于每个患者和每个手术所特有的特定血栓形成和出血风险之间的平衡。
