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STATE-OF-THE-ART PAPER

Perioperative Management of Patients With Coronary Stents

Emmanouil S. Brilakis, MD, PhD, FACC^_*,_*, Subhash Banerjee, MD, FACC^_* and Peter B. Berger, MD, FACC^,1

^_* Division of Cardiovascular Diseases, University of Texas Southwestern Medical Center, and Dallas VA Medical Center, Dallas, Texas
Geisinger Clinic, Danville, Pennsylvania.

Manuscript received December 12, 2006; revised manuscript received February 21, 2007, accepted February 27, 2007.

^_* Reprint requests and correspondence: Dr. Emmanouil S. Brilakis, Dallas VA Medical Center (111A), 4500 South Lancaster Road, Dallas, Texas 75216. (Email: emmanouil.brilakis{at}utsouthwestern.edu).

Perioperative coronary stent thrombosis is a catastrophic complication that can occur in patients receiving both bare-metal and drug-eluting stents. Noncardiac surgery appears to increase the risk that recently-placed stents thrombose, especially when surgery is performed early after stenting, and particularly if dual antiplatelet therapy is discontinued. We reviewed the existing data about the frequency of stent thrombosis after noncardiac surgery and explored the impact of delay from surgery and discontinuation of antiplatelet therapy. We also reviewed the data about the impact of preoperative revascularization in patients known to require noncardiac surgery. Based on these published data, we offer recommendations that can be used to guide the treatment of patients who require noncardiac surgery after having received a stent.

Abbreviations and Acronyms   AMI = acute myocardial infarction   BMS = bare-metal stent(s)   CI = confidence interval   DES = drug-eluting stent(s)   PCI = percutaneous coronary intervention   PES = paclitaxel-eluting stent(s)   SES = sirolimus-eluting stent(s)

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