Discontinuation of antiplatelet therapy prior to low-risk noncardiac surgery in patients with drug-eluting stents: A retrospective cohort study

Daniel Brotman, Mihir Bakhru, Wael Saber, Ashish Aneja, Deepak L. Bhatt, Katherina Tillan-Martinez, Amir K. Jaffer

Research output: Contribution to journalArticle

Abstract

Background: Drug-eluting coronary stents (DESs) pose a challenge in the peri-operative period. Sirolimus and paclitaxel may inhibit reendothelialization of the traumatized vessel, making it vulnerable to platelet-mediated thrombosis. Given the anecdotal evidence and case series suggesting that DESs may be more vulnerable to thrombosis on discontinuation of antiplatelet agents than are bare-metal stents, we sought to quantify this risk. Methods: We linked the Cleveland Clinic Heart Center database with the Cleveland Clinic Internal Medicine Preoperative Assessment Consultation and Treatment (IMPACT) Center database to identify all patients who had undergone DES placement at the Cleveland Clinic and subsequently were evaluated for noncardiac surgery between July 2003 and July 2005. Outcome measures included 30-day rate of postoperative myocardial infarction (MI), DES thrombosis, major bleeding, and all-cause mortality. Results: We identified 114 patients who underwent noncardiac surgery a median of 236 days (IQR 125-354) after stent placement. Forty-five patients (40%) underwent surgery within 180 days of stenting, 15 of whom (13%) underwent surgery within 90 days of stenting. Eighty-eight patients (77%) discontinued all antiplatelet agents a median of 10 days before surgery. No patients died. Two patients (1.8%, 95% CI 0.5%-6.2%) suffered postoperative Mis, but postoperative catheterization showed neither had DES thrombosis (0%, 95% CI 0%-3.3%). One patient developed major bleeding (0.9%, CI 0.2%-4.8%). Conclusions: These data suggest that the overall risk of stent thrombosis is low in low-risk noncardiac surgery patients with DESs, particularly those who have undergone ar least 180 days of antiplatelet therapy, even after complete discontinuation of antiplatelet agents.

Original languageEnglish (US)
Pages (from-to)378-384
Number of pages7
JournalJournal of Hospital Medicine
Volume2
Issue number6
DOIs
StatePublished - Nov 2007

Fingerprint

Drug-Eluting Stents
Cohort Studies
Retrospective Studies
Platelet Aggregation Inhibitors
Stents
Coronary Thrombosis
Thrombosis
Therapeutics
Databases
Hemorrhage
Sirolimus
Internal Medicine
Paclitaxel
Ambulatory Surgical Procedures
Catheterization
Referral and Consultation
Blood Platelets
Metals
Myocardial Infarction
Outcome Assessment (Health Care)

Keywords

  • Antiplatelet therapy
  • Drug-eluting stents
  • Myocardial infarction
  • Noncardiac surgery
  • Perioperative

ASJC Scopus subject areas

  • Health Policy
  • Assessment and Diagnosis
  • Care Planning
  • Fundamentals and skills
  • Leadership and Management

Cite this

Discontinuation of antiplatelet therapy prior to low-risk noncardiac surgery in patients with drug-eluting stents : A retrospective cohort study. / Brotman, Daniel; Bakhru, Mihir; Saber, Wael; Aneja, Ashish; Bhatt, Deepak L.; Tillan-Martinez, Katherina; Jaffer, Amir K.

In: Journal of Hospital Medicine, Vol. 2, No. 6, 11.2007, p. 378-384.

Research output: Contribution to journalArticle

Brotman, Daniel ; Bakhru, Mihir ; Saber, Wael ; Aneja, Ashish ; Bhatt, Deepak L. ; Tillan-Martinez, Katherina ; Jaffer, Amir K. / Discontinuation of antiplatelet therapy prior to low-risk noncardiac surgery in patients with drug-eluting stents : A retrospective cohort study. In: Journal of Hospital Medicine. 2007 ; Vol. 2, No. 6. pp. 378-384.
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abstract = "Background: Drug-eluting coronary stents (DESs) pose a challenge in the peri-operative period. Sirolimus and paclitaxel may inhibit reendothelialization of the traumatized vessel, making it vulnerable to platelet-mediated thrombosis. Given the anecdotal evidence and case series suggesting that DESs may be more vulnerable to thrombosis on discontinuation of antiplatelet agents than are bare-metal stents, we sought to quantify this risk. Methods: We linked the Cleveland Clinic Heart Center database with the Cleveland Clinic Internal Medicine Preoperative Assessment Consultation and Treatment (IMPACT) Center database to identify all patients who had undergone DES placement at the Cleveland Clinic and subsequently were evaluated for noncardiac surgery between July 2003 and July 2005. Outcome measures included 30-day rate of postoperative myocardial infarction (MI), DES thrombosis, major bleeding, and all-cause mortality. Results: We identified 114 patients who underwent noncardiac surgery a median of 236 days (IQR 125-354) after stent placement. Forty-five patients (40{\%}) underwent surgery within 180 days of stenting, 15 of whom (13{\%}) underwent surgery within 90 days of stenting. Eighty-eight patients (77{\%}) discontinued all antiplatelet agents a median of 10 days before surgery. No patients died. Two patients (1.8{\%}, 95{\%} CI 0.5{\%}-6.2{\%}) suffered postoperative Mis, but postoperative catheterization showed neither had DES thrombosis (0{\%}, 95{\%} CI 0{\%}-3.3{\%}). One patient developed major bleeding (0.9{\%}, CI 0.2{\%}-4.8{\%}). Conclusions: These data suggest that the overall risk of stent thrombosis is low in low-risk noncardiac surgery patients with DESs, particularly those who have undergone ar least 180 days of antiplatelet therapy, even after complete discontinuation of antiplatelet agents.",
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AU - Brotman, Daniel

AU - Bakhru, Mihir

AU - Saber, Wael

AU - Aneja, Ashish

AU - Bhatt, Deepak L.

AU - Tillan-Martinez, Katherina

AU - Jaffer, Amir K.

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N2 - Background: Drug-eluting coronary stents (DESs) pose a challenge in the peri-operative period. Sirolimus and paclitaxel may inhibit reendothelialization of the traumatized vessel, making it vulnerable to platelet-mediated thrombosis. Given the anecdotal evidence and case series suggesting that DESs may be more vulnerable to thrombosis on discontinuation of antiplatelet agents than are bare-metal stents, we sought to quantify this risk. Methods: We linked the Cleveland Clinic Heart Center database with the Cleveland Clinic Internal Medicine Preoperative Assessment Consultation and Treatment (IMPACT) Center database to identify all patients who had undergone DES placement at the Cleveland Clinic and subsequently were evaluated for noncardiac surgery between July 2003 and July 2005. Outcome measures included 30-day rate of postoperative myocardial infarction (MI), DES thrombosis, major bleeding, and all-cause mortality. Results: We identified 114 patients who underwent noncardiac surgery a median of 236 days (IQR 125-354) after stent placement. Forty-five patients (40%) underwent surgery within 180 days of stenting, 15 of whom (13%) underwent surgery within 90 days of stenting. Eighty-eight patients (77%) discontinued all antiplatelet agents a median of 10 days before surgery. No patients died. Two patients (1.8%, 95% CI 0.5%-6.2%) suffered postoperative Mis, but postoperative catheterization showed neither had DES thrombosis (0%, 95% CI 0%-3.3%). One patient developed major bleeding (0.9%, CI 0.2%-4.8%). Conclusions: These data suggest that the overall risk of stent thrombosis is low in low-risk noncardiac surgery patients with DESs, particularly those who have undergone ar least 180 days of antiplatelet therapy, even after complete discontinuation of antiplatelet agents.

AB - Background: Drug-eluting coronary stents (DESs) pose a challenge in the peri-operative period. Sirolimus and paclitaxel may inhibit reendothelialization of the traumatized vessel, making it vulnerable to platelet-mediated thrombosis. Given the anecdotal evidence and case series suggesting that DESs may be more vulnerable to thrombosis on discontinuation of antiplatelet agents than are bare-metal stents, we sought to quantify this risk. Methods: We linked the Cleveland Clinic Heart Center database with the Cleveland Clinic Internal Medicine Preoperative Assessment Consultation and Treatment (IMPACT) Center database to identify all patients who had undergone DES placement at the Cleveland Clinic and subsequently were evaluated for noncardiac surgery between July 2003 and July 2005. Outcome measures included 30-day rate of postoperative myocardial infarction (MI), DES thrombosis, major bleeding, and all-cause mortality. Results: We identified 114 patients who underwent noncardiac surgery a median of 236 days (IQR 125-354) after stent placement. Forty-five patients (40%) underwent surgery within 180 days of stenting, 15 of whom (13%) underwent surgery within 90 days of stenting. Eighty-eight patients (77%) discontinued all antiplatelet agents a median of 10 days before surgery. No patients died. Two patients (1.8%, 95% CI 0.5%-6.2%) suffered postoperative Mis, but postoperative catheterization showed neither had DES thrombosis (0%, 95% CI 0%-3.3%). One patient developed major bleeding (0.9%, CI 0.2%-4.8%). Conclusions: These data suggest that the overall risk of stent thrombosis is low in low-risk noncardiac surgery patients with DESs, particularly those who have undergone ar least 180 days of antiplatelet therapy, even after complete discontinuation of antiplatelet agents.

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