Kardiologie up2date 2011; 7(3): 170-172
DOI: 10.1055/s-0030-1256620
Hotline – Thrombozyten und Gerinnungssystem bei kardiovaskulären Erkrankungen

© Georg Thieme Verlag KG Stuttgart · New York

Perioperatives Management der antithrombotischen Behandlung bei Stent-Patienten

Boris  Bigalke
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
25. Oktober 2011 (online)

Abstract

Perioperative management of antiplatelet treatment in patients with coronary stents remains challenging as premature discontinuation may cause thrombotic events. To date, there is a lack of evidence-based results and guidelines to recommend adequate antithrombotic drug therapy in patients at high risk of stent thrombosis who undergo noncardiac surgery. According to our clinical experience with these patients, we propose a perioperative bridging of discontinued dual antiplatelet therapy by the „off-label“ use of low molecular weight glycoprotein IIbIIIa antagonist for up to 24 hours. Patients should be monitored by a perioperative point-of-care-testing and, thus, could benefit from the individually adapted antiplatelet therapeutic issue.

Literatur

  • 1 Cutlip D E, Baim D S, Ho K K et al. Stent thrombosis in the modern era: A pooled analysis of multicenter coronary stent clinical trials.  Circulation. 2001;  103 1967-1971
  • 2 Ong A T, Hoye A, Aoki J et al. Thirty-day incidence and six-month clinical outcome of thrombotic stent occlusion after bare-metal, sirolimus, or paclitaxel stent implantation.  J Am Coll Cardiol. 2005;  45 947-953
  • 3 Iakovou I, Schmidt T, Bonizzoni E et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents.  JAMA. 2005;  293 2126-2130
  • 4 Bigalke B, Geisler T, Hövelborn T et al. Management of perioperative stent thrombosis in patients undergoing surgery.  Platelets. 2010;  21 578-582
  • 5 Bigalke B, Seizer P, Geisler T et al. Perioperative antiplatelet therapy in patients at high risk for coronary stent thrombosis undergoing noncardiac surgery.  Clin Res Cardiol. 2009;  98 335-339
  • 6 Grines C L, Bonow R O, Casey D E et al. American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, American Dental Association, American College of Physicians. Prevention of premature discontinuation of dual-antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians.  Circulation. 2007;  115 813-818
  • 7 Bigalke B, Geisler T, Stellos K et al. Platelet collagen receptor glycoprotein VI as a possible novel indicator for the acute coronary syndrome.  Am Heart J. 2008;  156 193-200
  • 8 Dalen J E. Aspirin to prevent heart attack and stroke: what's the right dose?.  Ann J Med. 2006;  119 198-202
  • 9 Wilson S H, Fasseas P, Orford J L et al. Clinical outcome of patients undergoing non-cardiac surgery in the two months following coronary stenting.  J Am Coll Cardiol. 2003;  42 234-240
  • 10 Riddell J W, Chiche L, Plaud B et al. Coronary stents and noncardiac surgery.  Circulation. 2007;  116 378-382

Priv.-Doz. Dr. med. Boris Bigalke

Medizinische Klinik III
Eberhard-Karls-Universität Tübingen

Otfried-Müller-Str.10
72076 Tübingen

eMail: boris.bigalke@med.uni-tuebingen.de

    >