Noncardiac Surgery After PCI

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Information about Noncardiac Surgery After PCI
Education

Published on January 3, 2014

Author: terryshaneyfelt7

Source: slideshare.net

Description

In these slides I discuss what to do with the patient post stent who needs cardiac surgery and I discuss what to do with anti-platelet therapy in the perioperative period. Watch my YouTube description of these slides at http://youtu.be/J49mTAjLgyw

Noncardiac Surgery After PCI What to do? Terry Shaneyfelt, MD, MPH Assoc. Professor, UAB Department of Medicine

You must balance… Stent Thrombosis Bleeding

Adverse Cardiac Events Following Noncardiac Surgery in Patients With Stents Hawn, et al. JAMA 2013;310:1462

Approach to patients who need surgery after PCI Wait 6 weeks Wait 6 months Continue dual antiplatelet therapy if surgery needed before completion of recommended therapy No matter what continue at least aspirin* * Except for neurosurgery, post eye, middle ear, and prostate

To continue or discontinue aspirin in the perioperative period? A randomized, controlled clinical trial Oscarsson, et al. Br J Anaesth. 2010;104(3):305 • Aspirin (75 mg) or placebo was given 7 days before noncardiac surgery and continued until the third postoperative day. Patients were followed up for 30 days after surgery • Twelve patients (5.4%) had an MACE • 2/109 (1.8%) in the aspirin group and 10/111 (9.0%) in the placebo group (P=0.02) • 7.2% absolute risk reduction [95% CI, 1.3-13%], NNT 14 • RRR= 80% (95% CI, 9.2-95%) • No significant differences in bleeding complications were seen between the two groups

Managing antiplatelet agents in the perioperative period • Aspirin (and aspirin/dipyridamole) • Safe to continue except in high bleeding risk surgeries • The 2012 guidelines from the American College of Chest Physicians suggest continuing aspirin in patients at moderate to high risk for cardiovascular events who are undergoing noncardiac surgery • Stop 7-10 days prior to surgery • Bleeding time is a poor predictor of perioperative hemorrhage

Managing antiplatelet agents in the perioperative period • Platelet P2Y12 receptor blockers • Clopidogrel and ticagrelor: stop at least 5 days before surgery • Prasugrel: stop at least 7 days before surgery • Cilostazol • Selective phosphodiesterase-3 enzyme inhibitor with weak, reversible antiplatelet activity • Stop 5 days before surgery

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