Lege Artis Medicinae

[Perioperative management of patients with coronary stent in case of interventions other than cardiac surgery - Part I. - Perioperative treatment of patients with coronary stent]

ZIMA Endre, MEZŐFI Miklós, BECKER Dávid, SZABÓ György, MERKELY Béla, PÉNZES István

OCTOBER 20, 2011

Lege Artis Medicinae - 2011;21(10)

[Percutaneous coronary intervention (PCI) is meant to optimalise cardiac status, that is, short-term and long-term outcomes. It is known from large Western databases that stent implantation is performed in 77-85% of coronary interventions, which means hundreds of thousands of new patients with stent every year. The great majority of these patients has to take platelet aggregation inhibitors, namely acetylsalicylic acid and thienopyridin, most often clopidrogel. It presents a major therapeutic dilemma when these patients require noncardiac surgery. First, surgery should be performed with the least possible blood loss, which would be optimal if the platelet aggregation inhibitor therapy - that is indispensable for a certain period because of the stent - was suspended. Second, stent thrombosis has to be avoided, which can only be achieved if platelet aggregation inhibitor therapy is continued. The aim of our paper is to summarise the current guidelines and the risk estimation on the basis of our current knowledge in the perioperative management of patients with coronary stent. In the first part, we overview the platelet aggregation inhibitor agents, their mechanisms of effect, stent types and the minimal therapeutic period to be strictly observed, which depends on the type of stent.]

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