Preoperative management of antiplatelet drugs for a coronary artery stent: how can we hit a moving target?

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• 作者：Thomas R Vetter (1)
  James M Hunter Jr (1)
  Arthur M Boudreaux (1)
  
  1. Department of Anesthesiology ; School of Medicine ; University of Alabama at Birmingham ; 619 19th Street South ; JT804 ; Birmingham ; AL ; 35249-6810 ; USA
  
• 关键词：Coronary artery stent ; Antiplatelet therapy ; Preoperative ; Major adverse cardiac event ; Standardized clinical assessment and management plan ; Consensus ; oriented decision ; making model
• 刊名：BMC Anesthesiology
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：14
• 期：1
• 全文大小：1,172 KB
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  30. The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1471-2253/14/73/prepub
  
• 刊物主题：Anesthesiology; Internal Medicine; Emergency Medicine; Intensive / Critical Care Medicine;
• 出版者：BioMed Central
• ISSN：1471-2253

文摘

Background With the advent of percutaneous coronary intervention, specifically the bare metal stent and subsequently, the drug-eluting stent, the scope of interventional cardiology has greatly increased. Aspirin, in combination with a thienopyridine is the present-day cornerstone of oral antiplatelet therapy after coronary artery stent placement. Continuing this chronic antiplatelet therapy, to mitigate a perioperative major adverse cardiac event, can be challenging and remains controversial in patients with a coronary artery stent undergoing non-cardiac surgery. We describe here the rationale for and successful use of an alternate approach to formulating local institutional management protocols for patients with a coronary artery stent, undergoing an elective surgical procedure. Discussion A recent systematic review identified 11 clinical practice guidelines for the perioperative management of antiplatelet therapy in patients with a coronary stent who need non-cardiac surgery. However, there is significant variance and inadequacy with these current applicable professional society guidelines. Moreover, persistently variable success has been experienced in translating even well-grounded national clinical guidelines into local practice, including in the perioperative setting. Under the auspices of a broadly multidisciplinary institutional task force and applying the Consensus-Oriented Decision-Making model, we created two evidence-informed and local expert opinion-supported standardized clinical assessment and management plans for the preoperative management of antiplatelet therapy in patients with a coronary artery stent. Summary Patient care can be optimized via evidence-based, yet locally developed and reiterative standardized clinical assessment and management plans for patients with coronary artery stents undergoing surgical procedures. Such standardized clinical assessment and management plans can result in greater consistency in care, providing a positive feedback loop in which the care plan itself can be continuously reevaluated, improved, and brought up to date with the most recent available data and knowledge.