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Management of patients with coronary stents in elective thoracic surgery

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Abstract

Purpose

Interruption of oral antiplatelet agents for noncardiac surgery places patients who have received coronary stent implantation at high risk of coronary events, including stent thrombosis. We investigated retrospectively perioperative management for patients with coronary stents undergoing thoracic surgery.

Methods

We investigated 38 patients (age, 38–83 years; 33 men and 5 women) who underwent thoracic surgery (35 lung cancer resections and 3 other procedures) after coronary stent implantation at our hospital between January 2006 and August 2010. Data on implanted stents, perioperative medications, and cardiac and hemorrhagic complications were analyzed.

Results

Sirolimus-eluting stents (n = 18) and bare-metal stents (n = 20) were implanted. Regarding oral antiplatelet agents, 21 patients received aspirin, 16 received thienopyridine derivative and aspirin, and 1 received no oral antiplatelet agents. Oral antiplatelet agents were stopped 3–7 days before surgery. Perioperative heparinization was performed in 16 patients. Oral antiplatelet agents were restarted after confirmation of hemostasis and the lack of need for further invasive procedures (median, 4 days after surgery). No major cardiac events including stent thrombosis developed. There were no excessive intraoperative bleeding events related to oral antiplatelet agents or heparin.

Conclusions

In our patients, no coronary events occurred with the short-term stopping of oral antiplatelet agents for thoracic surgery.

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References

  1. Bavry AA, Kumbhani DJ, Quiroz R, Ramchandani SR, Kenchaiah S, Antman EM. Invasive therapy along with glycoprotein IIb/IIIa inhibitors and intracoronary stents improves survival in non-ST-segment elevation acute coronary syndromes: a meta-analysis and review of the literature. Am J Cardiol 2004;93:830–835.

    Article  PubMed  CAS  Google Scholar 

  2. Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Fleischmann KE, et al. 2009 ACCF/AHA focused update on perioperative beta blockade incorporated into the ACC/ AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2009;120:e169–e276.

    Article  PubMed  Google Scholar 

  3. McFadden EP, Stabile E, Regar E, Cheneau E, Ong AT, Kinnaird T, et al. Late thrombosis in drug eluting coronary stents after discontinuation of antiplatelet therapy. Lancet 2004;364;1519–1521.

    Article  PubMed  CAS  Google Scholar 

  4. Kaluza GI, Joseph J, Lee JR, Raizner ME, Raizner AE. Catastrophic outcomes of noncardiac surgery soon after coronary stenting. J Am Coll Cardiol 2000;35:1288–1294.

    Article  PubMed  CAS  Google Scholar 

  5. Wilson SH, Fasseas P, Orford JL, Lennon RJ, Horlocker T, Charnoff NE, et al. Clinical outcome of patients undergoing non-cardiac surgery in the two months following coronary stenting. J Am Coll Cardiol 2003;42:234–240.

    Article  PubMed  Google Scholar 

  6. Sharma AK, Ajani AE, Hamwi SM, Maniar P, Lakhani SV, Waksman R, et al. Major noncardiac surgery following coronary stenting: when is it safe to operate? Catheter Cardiovasc Interv 2004;63:141–145.

    Article  PubMed  Google Scholar 

  7. Reddy PR, Vaitkus PT. Risks of noncardiac surgery after coronary stenting. Am J Cardiol 2005;95:755–757.

    Article  PubMed  Google Scholar 

  8. Leibowitz D, Cohen M, Planer D, Mosseri M, Rott D, Lotan C, et al. Comparison of cardiovascular risk of noncardiac surgery following coronary angiography with versus without stenting. Am J Cardiol 2006;97:1188–1191.

    Article  PubMed  Google Scholar 

  9. Vicenzi MN, Meislitzer T, Heitzinger B, Halaj M, Fleisher LA, Metzler H. Coronary artery stenting and non-cardiac surgery: a prospective outcome study. Br J Anaesth 2006;96:686–693.

    Article  PubMed  CAS  Google Scholar 

  10. Schouten O, van Domburg RT, Bax JJ, de Jaegere PJ, Dunkelgrun MJ, Feringa HHH, et al. Noncardiac surgery after coronary stenting: early surgery and interruption of antiplatelet therapy are associated with an increase in major adverse cardiac events. Am Coll Cardiol 2007;49:122–124.

    Article  Google Scholar 

  11. Kimura T, Isshiki T, Hayashi Y, Oshima S, Namura M, Nakashima H, et al. Incidence and outcome of surgical procedures after sirolimus-eluting stent implantation: a report from the j-Cypher registry. Cardiovasc Interv Ther 2010;25:29–39.

    Article  Google Scholar 

  12. Brichon PY, Boitet P, Dujon A, Mouroux J, Peillon C, Riquet M, et al. Perioperative in-stent thrombosis after lung resection performed within 3 months of coronary stenting. Eur J Cardiothorac Surg 2006;30:793–796.

    Article  PubMed  Google Scholar 

  13. Compton PA, Zankar AA, Adesanya AO, Banerjee S, Brilakis ES. Risk of noncardiac surgery after coronary drug-eluting stent implantation. Am J Cardiol 2006;98:1212–1213.

    Article  PubMed  Google Scholar 

  14. Riddell JW, Chiche L, Plaud B, Hamon M. Coronary stents and noncardiac surgery. Circulation 2007;116:e378–382.

    Article  PubMed  Google Scholar 

  15. Luckie M, Khattar RS, Fraser D. Non-cardiac surgery and antiplatelet therapy following coronary artery stenting. Heart 2009;95:1303–1308.

    Article  PubMed  CAS  Google Scholar 

  16. Kimura T, Tamura T, Yokoi H, Nobuyoshi M. Long-term clinical and angiographic follow-up after placement of Palmaz-Schatz coronary stent: a single center experience. J Interv Cardiol 1994;7:129–139.

    Article  PubMed  CAS  Google Scholar 

  17. Kimura T, Morimoto T, Nakagawa Y, Tamura T, Kadota K, Yasumoto H, et al. Antiplatelet therapy and stent thrombosis after sirolimus-eluting stent implantation. Circulation 2009; 119:987–995.

    Article  PubMed  CAS  Google Scholar 

  18. Leon MB, Baim DS, Popma JJ, Gordon PC, Cutlip DE, Ho KK, et al. A clinical trial comparing three antithromboticdrug regimens after coronary-artery stenting. Stent Anticoagulation Restenosis Study Investigators. N Engl J Med 1998;339:1665–1671.

    Article  PubMed  CAS  Google Scholar 

  19. Daemen J, Wenaweser P, Tsuchida K, Abrecht L, Vaina S, Morger C, et al. Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study. Lancet 2007;369:667–678.

    Article  PubMed  CAS  Google Scholar 

  20. Montalescot G, Wiviott SD, Braunwald E, Murphy SA, Gibson CM, McCabe CH, et al. Prasugrel compared with clopidogrel in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (TRITON-TIMI 38): double-blind, randomised controlled trial. Lancet 2009;373:723–731.

    Article  PubMed  CAS  Google Scholar 

  21. Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Planczyk CA, Cook EF, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 1999;100:1043–1049.

    PubMed  CAS  Google Scholar 

  22. Grines CL, Bonow RO, Casey DE Jr, Gardner TJ, Lockhart PB, Moliterno DJ, et al. Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians. Circulation 2007;115:813–818.

    Article  PubMed  Google Scholar 

  23. Beijering RJ, ten Cate H, ten Cate JW. Clinical applications of new antithrombotic agents. Ann Hematol 1996;72:177–183.

    Article  PubMed  CAS  Google Scholar 

  24. Loeliger EA, Brockmans AW. Optimal therapeutic anticoagulation. Haemostasis 1985;15:283–292.

    PubMed  CAS  Google Scholar 

  25. Broad L, Lee T, Conroy M, Bolsin S, Orford N, Black A, Birdsey G. Successful management of patients with a drugeluting coronary stent presenting for elective, non-cardiac surgery. Br J Anaesth 2007;98:19–22.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Thoracic Surgery, Kyoto University Hospital, 54 Shogoin-Kawara-cho, Sakyo-ku, Kyoto, 606-8507, Kyoto, Japan

    Makoto Sonobe, Toshihiko Sato, Fengshi Chen, Takuji Fujinaga, Tsuyoshi Shoji, Hiroaki Sakai, Ryo Miyahara, Toru Bando, Chen-Long Huang & Hiroshi Date

Authors
  1. Makoto Sonobe
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  2. Toshihiko Sato
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  3. Fengshi Chen
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  4. Takuji Fujinaga
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  5. Tsuyoshi Shoji
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  6. Hiroaki Sakai
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  7. Ryo Miyahara
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  8. Toru Bando
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  9. Chen-Long Huang
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  10. Hiroshi Date
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Corresponding author

Correspondence to Makoto Sonobe.

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Sonobe, M., Sato, T., Chen, F. et al. Management of patients with coronary stents in elective thoracic surgery. Gen Thorac Cardiovasc Surg 59, 477–482 (2011). https://doi.org/10.1007/s11748-011-0775-3

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  • DOI: https://doi.org/10.1007/s11748-011-0775-3

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