Discontinuation of Antiplatelet Therapy Prior to Noncardiac Surgery in Patients with Drug‐Eluting Stents: A Retrospective Cohort Study

1Johns Hopkins Hospital, Baltimore, MD
2Cleveland Clinic, Cleveland, OH
3Johns Hopkins Hospital, Baltimore, MD

Meeting: Hospital Medicine 2007, May 23-25, Dallas, Texas

Abstract number: 12

Background:

Drug‐eluting coronary stents (DESs) pose a challenge in the perioperative setting. Sirolimus and paclitaxel may inhibit re‐endothelialization of the traumatized vessel, making it vulnerable to platelet‐mediated thrombosis. Given 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 rates 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 days) 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 preoperatively, including the majority of patients who underwent surgery within 90 or 180 days of stenting. No patients died. Two patients (1.8%, 95% CI: 0.5%‐6.2%) developed postoperative MI, but neither had DES thrombosis by postoperative catheterization (0%, 95% CI: 0%‐3.3%). One patient developed major bleeding (0.9%, 95% CI: 0.2%‐4.8%).

TABLE — 30‐Day Outcomes in Predefined Patient Subsets

Conclusions:

These data suggest that the overall risk of stent thrombosis is low in non‐cardiac surgery patients with DES, particularly those who have undergone at least 180 days of antiplatelet therapy, even after complete discontinuation of antiplatelet agents.

Author Disclosure:

D. J. Brotman, None; M. Bakhru, None; W. Saber, None; A. Aneja, None; D. L. Bhatt, Bristol Myers Squibb, research grants, consulting fees or other remuneration (payment), speakers bureau; sanofi‐aventis, research grants, consulting fees or other remuneration (payment), speakers bureau; Eisai, research grants, consulting fees or other remuneration (payment), speakers bureau; the Medicines Company, research grants, consulting fees or other remuneration (payment), speakers bureau; Astra Zenica, consulting fees or other remuneration (payment), nonremunerative positions of influence, speakers bureau; Centocor, consulting fees or other remuneration (payment), speakers bureau; Daiichi‐Sankyo, consulting fees or other remuneration (payment); Eli Lilly, consulting fees or other remuneration (payment); Glaxo Smith Kline, consulting fees or other remuneration (payment), nonremunerative positions of influence, speakers bureau; BDL, consulting fees or other remuneration (payment); K. Tillan‐Martinez, None; A. K. Jaffer, Prompte, consulting fees or other remuneration (payment).

To cite this abstract:

Brotman D, Bakhru M, Saber W, Aneja A, Bhatt D, Tillan‐Martinez K, Jaffer A. Discontinuation of Antiplatelet Therapy Prior to Noncardiac Surgery in Patients with Drug‐Eluting Stents: A Retrospective Cohort Study. Abstract published at Hospital Medicine 2007, May 23-25, Dallas, Texas Abstract 12. Journal of Hospital Medicine. 2007; 2 (suppl 2). https://www.shmabstracts.com/abstract/discontinuation-of-antiplatelet-therapy-prior-to-noncardiac-surgery-in-patients-with-drugeluting-stents-a-retrospective-cohort-study/. Accessed May 26, 2019.

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