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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

Abstract

Purpose

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.

Source

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.

Conclusion

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.

Keywords

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

Résumé

Objectif

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.

Source

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.

Conclusion

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.

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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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