Subscribe to RSS
DOI: 10.1055/s-0030-1256620
© Georg Thieme Verlag KG Stuttgart · New York
Perioperatives Management der antithrombotischen Behandlung bei Stent-Patienten
Publication History
Publication Date:
25 October 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 4
Bigalke B, Geisler T, Hövelborn T et al.
Management of perioperative stent thrombosis in patients undergoing surgery.
Platelets.
2010;
21
578-582
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 8
Dalen J E.
Aspirin to prevent heart attack and stroke: what's the right dose?.
Ann J Med.
2006;
119
198-202
Reference Ris Wihthout Link
- 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
Reference Ris Wihthout Link
- 10
Riddell J W, Chiche L, Plaud B et al.
Coronary stents and noncardiac surgery.
Circulation.
2007;
116
378-382
Reference Ris Wihthout Link
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