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Coronary artery stents and surgery;the basis of sound perioperative management

Health 2013年第10期5卷 1730-1736页

作者： stephen bolsin Chin Hiew Garth Birdsey Mark Colson Jessica Gillet Department of Anaesthesia Geelong Hospital Victoria Australia Department of Cardiology The Geelong Hospital Victoria Australia Department of Epidemiology & Preventative Medicine Monash University Melbourne Australia Geelong Hospital Pharmacy Victoria Australia

The introduction of drug-eluting stents (DES) to interventional cardiology heralded a limited time of increased anaesthetic and surgical complications in patients implanted with these devices. The horns of the dilemma, in the anaesthetic and surgical management of patients in the first 3-6 months after the 1st generation DES insertion, were between the risk of bleeding from continued clopidogrel treatment and the risk of instent thrombosis and myocardial infarction following discontinuation of dual antiplatelet therapy, clopidogrel and aspirin. Initial accounts of early catastrophic cardiac and haemorrhagic complications, at the time of elective or emergency surgery, following DES insertion, were followed by equally worrying reports of instent thrombosis many months after DES insertion. Initial recommendations for the conduct of safe operations were propagated in the literature before formal guidelines were produced. This article summarises the issues identified in the development of interventional cardiology particularly DES and the requirement for ongoing antiplatelet therapy. The article reviews the treatment protocols that are still applicable for the different devices that have been deployed in clinical practice.

关键词： Coronary Artery Stent Thrombosis Haemorrhage Surgery Complication

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