Perioperative management of oral antiplatelet therapy and impact on clinical outcomes in patients with coronary stents undergoing surgery: Results of a multicenter registry

 


To continue or discontinue antiplatelet therapy before surgery – that is the question

The recent publication by Roberta Rossini, MD, PhD, Cardiovascular Department, Ospedale Aapa Giovanni XXIIII, Bergamo, Italy, and her colleagues elucidated the clinical effects of perioperative antiplatelet therapy in detail in patients with coronary stents undergoing cardiac and non-cardiac surgery. The observational study revealed that 55.7 % of patients partly or completely discontinue antiplatelet medication before undergoing surgery. However, peri-operative antiplatelet discontinuation was the strongest independent predictor of 30-day major adverse cardiac events.

The aim of her study was to investigate the perioperative risk of ischemic events and bleeding episodes in patients with coronary stents. The primary efficacy endpoint was defined as 30-day incidence of major adverse cardiac events, i.e. the composite of cardiac death, myocardial infarction and stroke. The primary safety endpoint was defined as 30-day incidence of bleeding (Bleeding Academic Research Consortium). The data of the multicenter, retrospective, observational trial, including 666 patients at three Italian centers, revealed how outcomes were affected by the use of oral antiplatelet therapy in the perioperative and postoperative period. After summing up her findings, Dr Rossini underlined the importance of antiplatelet therapy in patients with coronary stents undergoing surgery, emphasizing that antiplatelet therapy discontinuation might expose these patients to a higher risk of cardiac death and heart attacks.

The results suggest that peri-operative antiplatelet discontinuation is associated with a significantly higher risk of cardiac death and acute myocardial infarction at 30 days in patients with coronary stents undergoing cardiac and non-cardiac surgery, even though not offering a significant protection from bleeding events.

To date, studies addressing the effect on bleeding were sparse and data demonstrating a protective role are not consistent, the author explained. The present study reinforces previous investigations suggesting that peri-operative withdrawal of antiplatelet therapy significantly increases the risk of cardiac death and heart attacks within 30 days after surgery in patients with coronary stents.

Rossini emphasized, “The results from our observational study are a strong call for caution with regards to oral antiplatelet drug discontinuation, given the high prevalence with which this occurs, not only for clopidogrel but also aspirin. Maintaining aspirin for most procedures and clopidogrel for non-high-bleeding-risk surgeries would be more prudent to reduce the risk of cardiovascular complications.”

Werner Zwick, M.A., Munich, Germany

Reference:
Roberta Rossini, Giuseppe Musumeci, Davide Capodanno et al.: Opens external link in new windowPerioperative management of oral antiplatelet therapy and impact on clinical outcomes in patients with coronary stents undergoing surgery: Results of a multicenter registry. Thromb Haemost 2015: 113/2 (Feb) pp. 221–435.


PR contact:
Stefanie Engelfried
public relations

Schattauer GmbH
Verlag für Medizin und Naturwissenschaften
Hölderlinstrasse 3
70174 Stuttgart
Tel: 0711-22987-20
Fax: 0711-22987-85
E-Mail: Öffnet ein Fenster zum Versenden der E-Mailstefanie.engelfried(at)schattauer.de