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Nov 2011

Major Abdominal Surgery With Continued Dual Antiplatelet Therapy

Author Affiliations

Author Affiliations: Departments of Visceral, Transplantation, Thoracic, and Vascular Surgery (Drs Quante, Benckert, Thelen, and Jonas) and Anesthesiology and Intensive Care Medicine (Dr Kaisers), University Hospital Leipzig, Germany.

Arch Surg. 2011;146(11):1334-1336. doi:10.1001/archsurg.2011.300

To our knowledge, large prospective studies with a high degree of evidence on antiplatelet regimens during noncardiac surgery are lacking. Recently, Chernoguz et al1 reported a significantly increased risk of postoperative bleeding in patients who received clopidogrel bisulfate before major abdominal surgery. An invited comment2 on their study1 pointed out that cessation of antiplatelet therapy can result in an increased risk of major adverse cardiac events due to stent thrombosis (eg, myocardial infarction and its possible fatal outcome). Current guidelines3 recommend that elective, noncardiac surgery be postponed for at least 6 weeks after the placement of bare-metal stents and for at least 1 year after the placement of drug-eluting stents. The question remains whether to continue or discontinue antiplatelet therapy and face the risk of either perioperative bleeding or adverse cardiac events, especially in urgent situations. With this question in mind, and in contrast to the study by Chernoguz et al,1 we report a small case series of 7 consecutive patients who underwent major abdominal surgery while receiving dual antiplatelet therapy in our hospital between October 2009 and July 2010.

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