Canadian Journal of Anesthesia

, 53:1230 | Cite as

Brief review: Coronary drug-eluting stents and anesthesia

  • Aparna R. Dalal
  • Stanlies D’;Souza
  • Mark S. Shulman
Cardiothoracic Anesthesia, Respiration and Airway



Anesthesiologists managing patients with drug-eluting stents (DES) face the challenge of balancing the risks of bleedingvs perioperative stent thrombosis (ST). This article reviews DES and the influence of antiplatelet medications related to their use. A perioperative management algorithm is suggested. Novel P2Y12 antagonists currently under investigation, including cangrelor and prasugrel are considered, as well as their potential role in modification of perioperative cardiovascular risks and management of patients with DES.


A PubMed search of the relevant literature over the period 1985–2005 was undertaken using the terms “drug-eluting stent”, “coronary artery stent”, “bare metal stent”, “antiplatelet medication”, “aspirin”, “clopidogrel.”

Principal findings

Delayed re-endothelialization may render both sirolimus-eluting and paclitaxel-eluting stents susceptible to thrombosis for a longer duration than bare metal stents. Stent thrombosis may be associated with resistance to antiplatelet medication. In patients with a DES, a preoperative cardiology consultation is essential. Elective surgery should be postponed if the duration between DES placement and noncardiac surgery is less than six months. For semi-emergent procedures, both aspirin and clopidogrel should be continued during surgery unless clearly contraindicated by the nature of the surgery. If the risk of bleeding is high, then modification of antiplatelet medications should be considered on a case-by-case basis.


A profound increase in the number of patients with DES requires anesthesiologists to be familiar with their associated antiplatelet medications, and strategies for risk modification of ST and possible hemorrhagic complications in the perioperative setting.


Aspirin Clopidogrel Antiplatelet Therapy Stent Thrombosis P2Y12 Receptor 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Article de synthèse court: Les tuteurs coronariens actifs et l’anesthésie



Les anesthésiologistes qui prennent en charge des patients porteurs de tuteurs coronariens actifs (TCA) font face au défi d’ëvaluer le risque de saignement en regard du risque de thrombose du tuteur dans la période périopératoire. Cet article traite des TCA et de l’influence des agents antiplaquettaires utilisés concurremment. Un algorithme de prise en charge est présenté. Les nouveaux antagonistes P2Y12 maintenant à l’essai, comme le cangrelor et le prasugrel, sont présentés, ainsi que leur rôle éventuel sur la modification du risque cardiovasculaire périopératoire et de la prise en charge des patients avec TCA.


Une recherche d’articles pertinents à l’aide de PubMed pour la période 1985–2005 a été entreprise en utilisant les termes “drug-eluting stent”, “coronary artery stent”, “bare metal stent”, “antiplatelet medication”, “aspirin”, “clopidogrel.”

Constatations principales

Les tuteurs au sirolimus et au paclitaxel retardent la réendothélialisation. Ils sont donc plus susceptibles de former une thrombose plus longtemps que les tuteurs métalliques nus. Une thrombose due au tuteur peut entraîner une résistance aux agents antiplaquettaires. Une consultation en cardiologie est essentielle pour les patients avec un TCA. Une chirurgie réglée doit être reportée pour les patients porteurs de TCA depuis moins de six mois. Pour les urgences relatives, il est recommandé de poursuivre le traitement à l’aspirine et au clopidogrel à moins que le type de chirurgie ne le contre-indique. Si le risque de saignement est élevé, une modification du traitement antiplaquettaire doit être envisagée au cas par cas.


À cause du nombre croissant de patients porteurs de TCA, les anesthésiologistes doivent se familiariser avec les agents antiplaquettaires et avec les stratégies visant à modifier le risque de thrombose et de complications hémorragiques possibles dans le cadre d’une chirurgie.


  1. 1.
    Hodgson JM, Klein LW, Bottner R, et al. SCAI Drugeluting Stent Task Force. Final report and recommendations of the working committees on cost effectiveness/economics, medical-legal issues and access to care, Catheter Cardiovasc Interv 2004; 62: 1–17.PubMedCrossRefGoogle Scholar
  2. 2.
    Iakovou I, Schmidt T, Bonnizoni E, et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA 2005; 293: 2126–30.PubMedCrossRefGoogle Scholar
  3. 3.
    Presbitero P, Boccuzzi G. Restenosis treatment in the drug-eluting stent era. Ital Heart J 2005; 6: 514–21.PubMedGoogle Scholar
  4. 4.
    Eagle KA, Berger PB, Calkins H, et al. ACC/AHA Guideline Update for Perioperative Cardiovascular Evaluation for Noncardiac Surgery — Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Anesth Analg 2002; 94: 1052–64.PubMedCrossRefGoogle Scholar
  5. 5.
    Serruys PW, Luijten HE, Beatt KJ, et al. Incidence of restenosis after successful coronary angioplasty: a timerelated phenomenon. A quantitative angiographic study in 342 consecutive patients at 1, 2, 3, and 4 months. Circulation 1988; 77: 361–71.PubMedGoogle Scholar
  6. 6.
    Liuzzo JP, Abrose JA, Coppala JT. Sirolimus — and taxol-eluting stents differ towards intimal hyperplasia and re-endothelialization. J Invasive Cardiol 2005; 17: 497–502.PubMedGoogle Scholar
  7. 7.
    Silber S, Albertsson P, Aviles FF, et al. Guidelines for percutaneous coronary interventions. The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology. Eur Heart J 2005; 26: 804–47.PubMedCrossRefGoogle Scholar
  8. 8.
    Curfman GD. Sirolimus-eluting coronary stents. N Engl J Med 2002; 346: 1770–1.PubMedCrossRefGoogle Scholar
  9. 9.
    Rogers CD. Drug-eluting stents: clinical perspectives on drug and design differences. Rev Cardiovasc Med 2005; 6(Suppl 1): S3–12.PubMedGoogle Scholar
  10. 10.
    Smith EJ, Rothman MT. Antiproliferative coatings for the treatment of coronary heart disease: what are the targets and which are the tools? J Interv Cardiol 2003: 16: 475–83.PubMedCrossRefGoogle Scholar
  11. 11.
    Moliterno DJ. Healing Achilles—sirolimus versus paclitaxel. N Engl J Med 2005; 353: 724–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Mauri L, Reisman M, Buchbinder M, et al. Comparison of rotational atherectomy with conventional balloon angioplasty in the prevention of restenosis of small coronary arteries: results of the Dilatation vs Ablation Revascularization Trial Targeting Restenosis (DART). Am Heart J 2003; 145: 847–54.PubMedCrossRefGoogle Scholar
  13. 13.
    Stone GW, Ellis SG, Cox DA, et al. One-year clinical results with the slow-release, polymer-based, paclitaxeleluting TAXUS stent: the TAXUS-IV trial. Circulation 2004; 109: 1942–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Holmes DR Jr, Leon MB, Moses JW, et al. Analysis of 1- year clinical outcomes in the SIRIUS trial: a randomized trial of a sirolimus-eluting stent versus a standard stent in patients at high risk for coronary restenosis. Circulation 2004; 109: 634–40.PubMedCrossRefGoogle Scholar
  15. 15.
    Buellesfeld L, Grube E. ABT-578-eluting stents. The promising successor of sirolimus- and paclitaxel-eluting stent concepts? Herz 2004; 29: 167–70.PubMedCrossRefGoogle Scholar
  16. 16.
    Kastrati A, Dibra A, Eberle S, et al. Sirolimus-eluting stents vs paclitaxel-eluting stents in patients with coronary artery disease: meta-analysis of randomized trials. JAMA 2005; 294: 819–25.PubMedCrossRefGoogle Scholar
  17. 17.
    Stone GW, Ellis SG, Cannon L, et al.;TAXUS V investigators. Comparison of a polymer-based paclitaxeleluting stent with a bare metal stent in patients with complex coronary artery disease: a randomized controlled trial. JAMA 2005; 14:294: 1215–23.CrossRefGoogle Scholar
  18. 18.
    Patrono C, Bachmann F, Baigent C, et al. Expert consensus document on the use of antiplatelet agents. The task force on the use of antiplatelet agents in patients with atherosclerotic cardiovascular disease of the European society of cardiology. Eur Heart J 2004; 25: 166–81.PubMedCrossRefGoogle Scholar
  19. 19.
    Gachet C. The platelet P2 receptors as molecular targets for old and new antiplatelet drugs. Pharmacol Ther 2005; 108: 180–92.PubMedCrossRefGoogle Scholar
  20. 20.
    Rozalski M, Nocun M, Watala C. Adenosine diphosphate receptors on blood platelets— potential new targets for antiplatelet therapy. Acta Biochim Pol 2005; 52: 411–5.PubMedGoogle Scholar
  21. 21.
    Boeynaems JM, van Giezen H, Savi P, Herbert JM. P2Y receptor antagonists in thrombosis. Curr Opin Investig Drugs 2005; 6: 275–82.PubMedGoogle Scholar
  22. 22.
    Antman EM, Anbe DT, Armstrong PW, et al. ACC/ AHA guidelines for the management of patients with ST-elevation myocardial infarction; a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. (Committee to Revise the 1999 Guidelines for the Management of patients with acute myocardial infarction) J Am Coll Cardiol 2004: 44: 671–719.PubMedCrossRefGoogle Scholar
  23. 23.
    Schwartz L, Bourassa MG, Lesperance J, et al. Aspirin and dipyridamole in the prevention of restenosis after percutaneous transluminal coronary angioplasty. N Engl J Med 1988; 318: 1714–9.PubMedGoogle Scholar
  24. 24.
    Peters RJ, Mehta SR, Fox KA, et al. Effects of aspirin dose when used alone or in combination with clopidogrel in patients with acute coronary syndromes: observations from the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) study. Circulation 2003; 108: 1682–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Jimenez AH, Stubbs ME, Tofler GH, Winther K, Williams GH, Muller JE. Rapidity and duration of platelet suppression by enteric-coated aspirin in healthy young men. Am J Cardiol 1992; 69: 258–62.PubMedCrossRefGoogle Scholar
  26. 26.
    Bertrand ME, Rupprecht HJ, Urban P, Gershlick AH, Investigators FT. Double-blind study of the safety of clopidogrel with and without a loading dose in combination with aspirin compared with ticlopidine in combination with aspirin after coronary stenting: the clopidogrel aspirin stent international cooperative study (CLASSICS). Circulation 2000; 102: 624–9.PubMedGoogle Scholar
  27. 27.
    Schomig A, Neumann FJ, Kastrati A, et al. A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary-artery stents. N Engl J Med 1996; 334: 1084–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Fischman DL, Leon MB, Baim DS, et al. A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. Stent Restenosis Study Investigators. N Engl J Med 1994; 331: 496–501.PubMedCrossRefGoogle Scholar
  29. 29.
    Leon MB, Baim DS, Popma JJ, et al. A clinical trial comparing three antithrombotic-drug regimens after coronary-artery stenting. Stent Anticoagulation Restenosis Study Investigators. N Engl J Med 1998; 339: 1665–71.PubMedCrossRefGoogle Scholar
  30. 30.
    Rubboli A, Milandri M, Castelvetri C, Cosmi B. Metaanalysis of trials comparing oral anticoagulation and aspirin versus dual antiplatelet therapy after coronary stenting. Clues for the management of patients with an indication for long-term anticoagulation undergoing coronary stenting. Cardiology 2005; 104: 101–6.PubMedCrossRefGoogle Scholar
  31. 31.
    Akbulut M, Ozbay Y, Karaca I, Ilkay E, Gundogdu O, Arslan N. The effect of long-term clopidogrel use on neointimal formation after percutaneous coronary intervention. Coron Artery Dis 2004; 15: 347–52.PubMedCrossRefGoogle Scholar
  32. 32.
    Smith SC Jr,Feldman TE, Hirschfeld JW Jr, et al. ACC/AHA /SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update 2001 Guidelines for Percutaneous Coronary Intervention). Circulation 2006: 113: e166–286.PubMedCrossRefGoogle Scholar
  33. 33.
    von Mach MA, Eich A, Wielemann LS, Munzel T. Subacute coronary stent thrombosis in a patient developing clopidogrel associated thrombotic thrombocytopenic purpura. Heart 2005; 91: e14.CrossRefGoogle Scholar
  34. 34.
    Hankey GJ, Eikelboom JW. Aspirin resistance. Lancet 2006; 367: 606–17.PubMedCrossRefGoogle Scholar
  35. 35.
    Wiviott SD, Antman EM. Clopidogrel resistance: a new chapter in a fast-moving story. Circulation 2004; 109: 3064–7.PubMedCrossRefGoogle Scholar
  36. 36.
    Nguyen TA, Diodati JG, Pharand C. Resistance to clopidogrel: a review of the evidence. J Am Coll Cardiol 2005; 45: 1157–64.PubMedCrossRefGoogle Scholar
  37. 37.
    Jaremo P, Lindahl TL, Fransson SG, Richter A. Individual variations of platelet inhibition after loading doses of clopidogrel. J Intern Med 2002; 252: 233–8.PubMedCrossRefGoogle Scholar
  38. 38.
    Gurbel PA, Bliden KP, Hiatt BL, O’Connor CM. Clopidogrel for coronary stenting: response variability, drug resistance, and the effect of pretreatment platelet reactivity. Circulation 2003; 107: 2908–13.PubMedCrossRefGoogle Scholar
  39. 39.
    Muller I, Besta F, Schulz C, Massberg S, Schonig A, Gawaz M. Prevalence of clopidogrel non-responders among patients with stable angina pectoris scheduled for elective coronary stent placement, Thromb Haemost 2003; 89: 783–7.PubMedGoogle Scholar
  40. 40.
    Mobley JE, Bresee SJ, Wortham DC, Craft RM, Snider CC, Carroll RC. Frequency of nonresponse antiplatelet activity of clopidogrel during pretreatment for cardiac catheterization. Am J Cardiol 2004; 93: 456–8.PubMedCrossRefGoogle Scholar
  41. 41.
    Angiolillo DJ, Fernandez-Ortiz A, Bernardo E, et al. Platelet aggregation according to body mass index in patients undergoing coronary stenting: should clopidogrel loading-dose be weight adjusted? J Invasive Cardiol 2004; 16: 169–74.PubMedGoogle Scholar
  42. 42.
    Serebruany VL, Steinhubl SR, Berger PB, Malinin AI, Bhatt DL, Topol, EJ. Variability in platelet responsiveness to clopidogrel among 544 individuals. J Am Coll Cardiol 2005; 45: 246–51.PubMedCrossRefGoogle Scholar
  43. 43.
    Matetzky S, Shenkman B, Guetta V, et al. Clopidogrel resistance is associated with increased risk of recurrent atherothrombotic events in patients with acute myocar- dial infarction. Circulation 2004; 109: 3171–5.PubMedCrossRefGoogle Scholar
  44. 44.
    Geiger J, Teichmann L, Grossman R, et al. Monitoring of clopidogrel action: comparison of methods. Clin Chem 2005; 51: 957–65.PubMedCrossRefGoogle Scholar
  45. 45.
    Eagle KA, Guyton RA, Davidoff R, et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation 2004: 110: e340–437.PubMedCrossRefGoogle Scholar
  46. 46.
    Takahara M, Usuba A, Endou G, et al. Evaluation of factors aggravating and delaying recovery from postoperative hypercoagulable state in patients operated on for esophageal cancer (Japanese). Nippon Kyobu Geka Gakkai Zasshi 1993; 41: 1133–42.PubMedGoogle Scholar
  47. 47.
    Eagle KA, Berger PB, Calkins H, et al. ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery -- executive summary: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). J Am Coll Cardiol 2002; 39: 542–53.PubMedCrossRefGoogle Scholar
  48. 48.
    Horlocker TT, Wedel DJ, Benzon H, et al. Regional anesthesia in the anticoagulated patient: defining the risks (the second ASRA Consensus Conference on Neuraxial Anesthesia and Anticoagulation). Reg Anesth Pain Med 2003; 28: 172–97.PubMedCrossRefGoogle Scholar
  49. 49.
    Rodriguez AE, Mieres J, Fernandez-Pereira C, et al. Coronary stent thrombosis in current drug-eluting stent era: insights from ERACI III trial. J Am Coll Cardiol 2006; 47: 205–7.PubMedCrossRefGoogle Scholar
  50. 50.
    Cutlip DE, Baim DS, Ho KK, et al. Stent thrombosis in the modern era: a pooled analysis of multicenter coronary stent clinical trials. Circulation 2001; 103: 1967–71.PubMedGoogle Scholar
  51. 51.
    Karvouni E, Korovesis S, Katritsis DG. Very late thrombosis after implantation of sirolimus eluting stent. Heart 2005; 91: e45.PubMedCrossRefGoogle Scholar
  52. 52.
    Lee CH, Tan HC, Ong HY, Teo SG, Lim YT. Late thrombotic occlusion of paclitaxel eluting stent more than one year after stent implantation. Heart 2004; 90: 1482.PubMedCrossRefGoogle Scholar
  53. 53.
    McFadden EP, Stabile E, Regar E, et al. Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy. Lancet 2004; 364: 1519–21.PubMedCrossRefGoogle Scholar
  54. 54.
    Moreno R, Fernandez C, Hernandez R, et al. Drugeluting stent thrombosis: results from a pooled analysis including 10 randomized studies. J Am Coll Cardiol 2005; 45: 954–9.PubMedCrossRefGoogle Scholar
  55. 55.
    Farb A, Burke AP, Kolodgie FD, Virmani R. Pathological mechanisms of fatal late coronary stent thrombosis in humans. Circulation 2003; 108: 1701–6.PubMedCrossRefGoogle Scholar
  56. 56.
    Ong AT, McFadden EP, Regar E, de Jaegere PP, van Domburg RT, Serruys PW. Late angiographic stent thrombosis (LAST) events with drug-eluting stents. J Am Coll Cardiol 2005; 45: 2088–92.PubMedCrossRefGoogle Scholar
  57. 57.
    Ortolani P, Ardissino D, Cavallini C, et al. Effect of sirolimus-eluting stent in diabetic patients with small coronary arteries (a SES-SMART substudy). Am J Cardiol 2005; 96: 1393–8.PubMedCrossRefGoogle Scholar
  58. 58.
    Iakovou I, Agostoni P, Cavallini C,et al. A simple risk score for prediction of thrombosis after drug-eluting stent implantation. European Society of Cardiology Congress 2005; 3749 (abstract).Google Scholar
  59. 59.
    Wenaweser P, Dorffler-Melly J, Imboden K, et al. Stent thrombosis is associated with an impaired response to antiplatelet therapy. J Am Coll Cardiol 2005; 45: 1748–52.PubMedCrossRefGoogle Scholar
  60. 60.
    von Beckerath N, Taubert D, Pogatsa-Murray G, et al. A patient with stent thrombosis, clopidogrel-resistance and failure to metabolize clopidogrel to its active metabolite. Thromb Haemost 2005; 93: 789–91.Google Scholar
  61. 61.
    Satler LF. Recommendations regarding stent selection in relation to the timing of noncardiac surgery postpercutaneous coronary intervention. Catheter Cardiovasc Interv 2004; 63: 146–7.PubMedCrossRefGoogle Scholar
  62. 62.
    Kaluza GL, Joseph J, Lee JR, Raizner ME, Raizner AE. Catastrophic outcomes of noncardiac surgery soon after coronary stenting. J Am Coll Cardiol 2000; 35: 1288–94.PubMedCrossRefGoogle Scholar
  63. 63.
    Auer J, Berent R, Weber T, Eber B. Risk of noncardiac surgery in the months following placement of drugeluting coronary stent (Letter). J Am Coll Cardiol 2004; 43: 713.PubMedCrossRefGoogle Scholar
  64. 64.
    Murphy JT, Fahy BG. Thrombosis of sirolimus-eluting coronary stent in the postanesthesia care unit. Anesth Analg 2005; 101: 971–3.PubMedCrossRefGoogle Scholar
  65. 65.
    Payne DA, Hayes PD, Jones CI, Belham P, Naylor AR, Goodall AH. Combined therapy with clopidogrel and aspirin significantly increases the bleeding time through a synergistic antiplatelet action. J Vasc Surg 2002; 35: 1204–9.PubMedCrossRefGoogle Scholar
  66. 66.
    Chapman TW, Bowley DM, Lambert AW, Walker AJ, Ashley SA, Wilkins DC. Haemorrhage associated with combined clopidogrel and aspirin therapy. Eur J Vasc Endovasc Surg 2001; 22: 478–9.PubMedCrossRefGoogle Scholar
  67. 67.
    Anonymous. Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: Pulmonary Embolism Prevention (PEP) trial. Lancet 2000; 355: 1295–302.Google Scholar
  68. 68.
    Moore M, Power M. Perioperative hemorrhage and combined clopidogrel and aspirin therapy. Anesthesiology 2004; 101: 792–4.PubMedCrossRefGoogle Scholar
  69. 69.
    Reich DL, Patel GC, Vela-Cantos F, Bodian C, Lansman S. Aspirin does not increase homologous blood requirements in elective coronary bypass surgery. Anesth Analg 1994; 79: 4–8.PubMedCrossRefGoogle Scholar
  70. 70.
    Rawitscher RE, Jones JW, McCoy TA, Lindsley DA. A prospective study of aspirin’s effect on red blood cell loss in cardiac surgery. J Cardiovasc Surg (Torino) 1991; 32: 1–7.Google Scholar
  71. 71.
    Chu MW, Wilson SR, Novick RJ, Stitt LW, Quantz MA. Does clopidogrel increase blood loss following coronary artery bypass surgery? Ann Thorac Surg 2004; 78: 1536–41PubMedCrossRefGoogle Scholar
  72. 72.
    Karabulut H, Toraman F, Evrenkaya S, Goksel O, Tarcan S, Alhan C. Clopidogrel does not increase bleeding and allogenic blood transfusion in coronary artery surgery. Eur J Cardiothorac Surg 2004; 25: 419–23.PubMedCrossRefGoogle Scholar
  73. 73.
    Anonymous. Practice parameter for the use of fresh-frozen plasma, cryoprecipitate, and platelets. Fresh-Frozen Plasma, Cryoprecipitate, and Platelets Administration Practice Guidelines Development Task Force of the College of American Pathologists. JAMA 1994; 271: 777–81.Google Scholar
  74. 74.
    Rebulla P. Trigger for platelet transfusion. Vox Sang 2000; 78(Suppl 2): 179–82.PubMedGoogle Scholar
  75. 75.
    Murphy MF, Brozovic B, Murphy W, Ouwehand W, Waters AH. Guidelines for platelet transfusions. British Committee for Standards in Haematology, Working Party of the Blood Transfusion Task Force. Transfus Med 1992; 2: 311–8.PubMedCrossRefGoogle Scholar
  76. 76.
    Contreras M. Final statement from the consensus conference on platelet transfusion. Transfusion 1998; 38: 796–7.PubMedCrossRefGoogle Scholar
  77. 77.
    Hay A, Olsen KR, Nicholson DH. Bleeding complications in thrombocytopenic patients undergoing ophthalmic surgery. Am J Ophtalmol 1990; 109: 482–3.Google Scholar
  78. 78.
    Rolbin SH, Abbott D, Musclow E, Papsin F, Lie LM, Freedman J. Epidural anesthesia in pregnant patients with low platelet counts. Obstet Gynecol 1988; 71(6 Pt 1): 918–20.PubMedGoogle Scholar
  79. 79.
    Edelson RN, Chernik NL, Posner JB. Spinal subdural hematomas complicating lumbar puncture. Arch Neurol 1974; 31: 134–7.PubMedGoogle Scholar
  80. 80.
    Beilin Y, Zahn J, Comerford M. Safe epidural analgesia in thirty parturients with platelet counts between 69,000 and 98,000 mm(-3). Anesth Analg 1997; 85: 385–8.PubMedCrossRefGoogle Scholar
  81. 81.
    Hew-Wing P, Rolbin SH, Hew E, Amato D. Epidural anaesthesia and thrombocytopenia. Anaesthesia 1989; 44: 775–7.PubMedCrossRefGoogle Scholar
  82. 82.
    Vandermeulen EP, Van Aken H, Vermylen J. Anticoagulants and spinal-epidural anaesthesia. Anesth Analg 1994; 79: 1165–77.PubMedCrossRefGoogle Scholar
  83. 83.
    Miller RD. Transfusion therapy.In: Miller RD (Ed). Anesthesia, 6th ed. New York: Elsevier; 2005: 1822–3.Google Scholar
  84. 84.
    Samama CM, Djoudi R, Lecompte T, Nathan-Denizot N, Schved JF;Agence Française de Sécurité Sanitaire des Produits de Santé expert group. Perioperative platelet transfusion: recommendations of the Agence Française de Sécurité Sanitaire des Produits de Santé (AFSSaPS) 2003. Can J Anesth 2005; 52: 30–7.PubMedCrossRefGoogle Scholar
  85. 85.
    Husted S, Emanuelsson H, Heptinstall S, Sandset PM, Wickens M, Peters G. Pharmacodynamics, pharmacokinetics, and safety of the oral reversible P2Y12 antagonist AZD6140 with aspirin in patients with atherosclerosis: a double-blind comparison to clopidogrel with aspirin. Eur Heart J 2006; 27: 1038–47.PubMedCrossRefGoogle Scholar
  86. 86.
    van Giezen JJ, Humphries RG. Preclinical and clinical studies with selective reversible direct P2Y12 antagonists. Semin Thromb Hemost 2005; 31: 195–204.PubMedCrossRefGoogle Scholar
  87. 87.
    Behan MW, Fox SC, Heptinstall S, Storey RF. Inhibitory effects of P2Y12 receptor antagonists on TRAP-induced platelet aggregation, procoagulant activity, micro particle formation and intracellular calcium responses in patients with acute coronary syndromes. Platelets 2005; 16: 73–80.PubMedCrossRefGoogle Scholar
  88. 88.
    Chattaraj SC. Cangrelor AstraZeneca. Curr Opin Investig Drugs 2001; 2: 250–5.PubMedGoogle Scholar
  89. 89.
    Storey RF, Oldroyd KG, Wilcox RG. Open multicentre study of the P2T receptor antagonist AR-C69931MX assessing safety, tolerability and activity in patients with acute coronary syndromes. Thromb Haemost 2001; 85: 401–7.PubMedGoogle Scholar
  90. 90.
    Storey RF, May JA, Heptinstall S. Potentiation of platelet aggregation by heparin in human whole blood is attenuated by P2Y12 and P2Y1 receptor antagonists but not aspirin. Thromb Res 2005; 115: 301–7.PubMedCrossRefGoogle Scholar
  91. 91.
    Niitsu Y, Sugidachi A, Hasegawa M, et al. CS-747 (Prasugrel, LY640315), a novel antiplatelet agent inhibits arterial thrombosis through selective blockade of platelet P2Y12 receptors. J Thromb Haemost 2005; 3(Suppl 1): 1708.Google Scholar
  92. 92.
    Niitsu Y, Jakubowski JA, Sugidachi A, Asai F. Pharmacology of CS-747 (prasugrel, LY640315), a novel, potent antiplatelet agent with in vivo P2Y12 receptor antagonist activity. Semin Thromb Hemost 2005; 31: 184–94.PubMedCrossRefGoogle Scholar
  93. 93.
    Sugidachi A, Asai F, Ogawa T, Inoue T, Koike H. The in vivo pharmacological profile of CS-747, a novel antiplatelet agent with platelet ADP receptor antagonist properties. Br J Pharmacol 2000; 129: 1439–46.PubMedCrossRefGoogle Scholar
  94. 94.
    Wiviott SD, Antman EM, Winters KJ, et al. Randomized comparison of prasugrel (CS-747, LY640315), a novel thienopyridine P2Y12 antagonist, with clopidogrel in percutaneous coronary intervention: results of the Joint Utilization of Medications to Block Platelets Optimally (JUMBO)-TIMI 26 trial. Circulation. 2005; 111: 3366–73.PubMedCrossRefGoogle Scholar
  95. 95.
    Dai K, Bodnar R, Berndt MC, Du X. Critical role for 14-3-3zeta protein in regulating the VWF binding function of platelet glycoprotein Ib-IX and its therapeutic implications. Blood 2005; 106: 1975–81.PubMedCrossRefGoogle Scholar
  96. 96.
    Momi S, Pitchford SC, Alberti PF, Minuz P, Del Soldato P, Gresele P. Nitroaspirin plus clopidogrel versus aspirin plus clopidogrel against platelet thromboembolism and intimal thickening in mice. Thromb Haemost 2005; 93: 535–43.PubMedGoogle Scholar

Copyright information

© Canadian Anesthesiologists 2006

Authors and Affiliations

  • Aparna R. Dalal
    • 1
  • Stanlies D’;Souza
    • 1
  • Mark S. Shulman
    • 1
  1. 1.Department of Anesthesiology and Pain MedicineCaritas St. Elizabeth’s Medical CenterBostonUSA

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