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July 11, 2017

Antiplatelet Therapy in Patients With Coronary Stents Undergoing Elective Noncardiac SurgeryContinue, Stop, or Something in Between?

Author Affiliations
  • 1Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
  • 2Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
JAMA. 2017;318(2):120-121. doi:10.1001/jama.2017.7845

Surgeons, cardiologists, primary care physicians, and anesthesiologists frequently make decisions regarding antiplatelet management for patients undergoing elective surgery. Patients with recent coronary stent implantation can be particularly challenging as clinicians balance the cardiac risks of discontinuing therapy with the bleeding risks of continuing antiplatelet agents. More than 600 000 patients receive coronary stents annually in the United States, with up to 23% of these individuals requiring noncardiac surgery within 2 years.1 Observational evidence suggests that patients who have undergone percutaneous coronary intervention with stent implantation are at increased risk of perioperative major adverse cardiac events (MACE) and that this risk is moderated by stent type (bare metal stent [BMS] vs drug-eluting stent [DES]), operative urgency, early discontinuation of antiplatelet therapy, and time from coronary intervention.2-4

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