Abstract
Management of antiplatelet agents in the perioperative setting is a common clinical challenge. Although discontinuation of aspirin therapy in patients who are taking aspirin for primary or secondary prevention is common, premature cessation of antiplatelet therapy in a patient with a prior drug-eluting stent is the single most important predictor of stent thrombosis, which carries a high morbidity and mortality. Therefore, these patients should ideally continue their antiplatelet therapy throughout surgery. However, this approach to reducing the risk of stent thrombosis must be counterbalanced by the increased risk of surgical bleeding. Multiple factors require evaluation to appropriately balance the risk of stent thrombosis against the risk of surgical bleeding. These include the type and timing of surgery, type and location of coronary stents if present, extent of coronary artery disease, and patient-specific risk factors. In general, for patients with coronary stents, all elective surgeries should be delayed until dual antiplatelet therapy is no longer crucial. Most surgical procedures may be performed on aspirin with acceptable risk of bleeding.
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Abualsaud, A.O., Eisenberg, M.J. (2014). Management of Antiplatelet Agents in the Perioperative Setting. In: Stergiopoulos, K., Brown, D. (eds) Evidence-Based Cardiology Consult. Springer, London. https://doi.org/10.1007/978-1-4471-4441-0_37
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DOI: https://doi.org/10.1007/978-1-4471-4441-0_37
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