A Multidisciplinary Approach on the Perioperative Antithrombotic Management of Patients With Coronary Stents Undergoing Surgery: Surgery After Stenting 2

Italian Society of Interventional Cardiology (SICI-GISE)

Research output: Contribution to journalReview article

Abstract

Perioperative management of antithrombotic therapy in patients treated with coronary stents undergoing surgery remains poorly defined. Importantly, surgery represents a common reason for premature treatment discontinuation, which is associated with an increased risk in mortality and major adverse cardiac events. However, maintaining antithrombotic therapy to minimize the incidence of perioperative ischemic complications may increase the risk of bleeding complications. Although guidelines provide some recommendations with respect to the perioperative management of antithrombotic therapy, these have been largely developed according to the thrombotic risk of the patient and a definition of the hemorrhagic risk specific to each surgical procedure, key to defining the trade-off between ischemia and bleeding, is not provided. These observations underscore the need for a multidisciplinary collaboration among cardiologists, anesthesiologists, hematologists and surgeons to reach this goal. The present document is an update on practical recommendations for standardizing management of antithrombotic therapy management in patients treated with coronary stents (Surgery After Stenting 2) in various types of surgery according to the predicted individual risk of thrombotic complications against the anticipated risk of surgical bleeding complications. Cardiologists defined the thrombotic risk using a "combined ischemic risk" approach, while surgeons classified surgeries according to their inherent hemorrhagic risk. Finally, a multidisciplinary agreement on the most appropriate antithrombotic treatment regimen in the perioperative phase was reached for each surgical procedure.

Original languageEnglish
Pages (from-to)417-434
Number of pages18
JournalJACC: Cardiovascular Interventions
Volume11
Issue number5
DOIs
Publication statusPublished - Mar 12 2018

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Hemorrhage
Stents
Therapeutics
Ischemia
Guidelines
Mortality
Incidence
Cardiologists
Surgeons
Anesthesiologists

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A Multidisciplinary Approach on the Perioperative Antithrombotic Management of Patients With Coronary Stents Undergoing Surgery : Surgery After Stenting 2. / Italian Society of Interventional Cardiology (SICI-GISE).

In: JACC: Cardiovascular Interventions, Vol. 11, No. 5, 12.03.2018, p. 417-434.

Research output: Contribution to journalReview article

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title = "A Multidisciplinary Approach on the Perioperative Antithrombotic Management of Patients With Coronary Stents Undergoing Surgery: Surgery After Stenting 2",
abstract = "Perioperative management of antithrombotic therapy in patients treated with coronary stents undergoing surgery remains poorly defined. Importantly, surgery represents a common reason for premature treatment discontinuation, which is associated with an increased risk in mortality and major adverse cardiac events. However, maintaining antithrombotic therapy to minimize the incidence of perioperative ischemic complications may increase the risk of bleeding complications. Although guidelines provide some recommendations with respect to the perioperative management of antithrombotic therapy, these have been largely developed according to the thrombotic risk of the patient and a definition of the hemorrhagic risk specific to each surgical procedure, key to defining the trade-off between ischemia and bleeding, is not provided. These observations underscore the need for a multidisciplinary collaboration among cardiologists, anesthesiologists, hematologists and surgeons to reach this goal. The present document is an update on practical recommendations for standardizing management of antithrombotic therapy management in patients treated with coronary stents (Surgery After Stenting 2) in various types of surgery according to the predicted individual risk of thrombotic complications against the anticipated risk of surgical bleeding complications. Cardiologists defined the thrombotic risk using a {"}combined ischemic risk{"} approach, while surgeons classified surgeries according to their inherent hemorrhagic risk. Finally, a multidisciplinary agreement on the most appropriate antithrombotic treatment regimen in the perioperative phase was reached for each surgical procedure.",
author = "{Italian Society of Interventional Cardiology (SICI-GISE)} and Roberta Rossini and Giuseppe Tarantini and Giuseppe Musumeci and Giulia Masiero and Emanuele Barbato and Paolo Calabr{\`o} and Davide Capodanno and Sergio Leonardi and Maddalena Lettino and Ugo Limbruno and Alberto Menozzi and Marchese, {U O Alfredo} and Francesco Saia and Marco Valgimigli and Walter Ageno and Anna Falanga and Antonio Corcione and Alessandro Locatelli and Marco Montorsi and Diego Piazza and Andrea Stella and Antonio Bozzani and Alessandro Parolari and Roberto Carone and Angiolillo, {Dominick J}",
note = "Copyright {\circledC} 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.",
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T1 - A Multidisciplinary Approach on the Perioperative Antithrombotic Management of Patients With Coronary Stents Undergoing Surgery

T2 - Surgery After Stenting 2

AU - Italian Society of Interventional Cardiology (SICI-GISE)

AU - Rossini, Roberta

AU - Tarantini, Giuseppe

AU - Musumeci, Giuseppe

AU - Masiero, Giulia

AU - Barbato, Emanuele

AU - Calabrò, Paolo

AU - Capodanno, Davide

AU - Leonardi, Sergio

AU - Lettino, Maddalena

AU - Limbruno, Ugo

AU - Menozzi, Alberto

AU - Marchese, U O Alfredo

AU - Saia, Francesco

AU - Valgimigli, Marco

AU - Ageno, Walter

AU - Falanga, Anna

AU - Corcione, Antonio

AU - Locatelli, Alessandro

AU - Montorsi, Marco

AU - Piazza, Diego

AU - Stella, Andrea

AU - Bozzani, Antonio

AU - Parolari, Alessandro

AU - Carone, Roberto

AU - Angiolillo, Dominick J

N1 - Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

PY - 2018/3/12

Y1 - 2018/3/12

N2 - Perioperative management of antithrombotic therapy in patients treated with coronary stents undergoing surgery remains poorly defined. Importantly, surgery represents a common reason for premature treatment discontinuation, which is associated with an increased risk in mortality and major adverse cardiac events. However, maintaining antithrombotic therapy to minimize the incidence of perioperative ischemic complications may increase the risk of bleeding complications. Although guidelines provide some recommendations with respect to the perioperative management of antithrombotic therapy, these have been largely developed according to the thrombotic risk of the patient and a definition of the hemorrhagic risk specific to each surgical procedure, key to defining the trade-off between ischemia and bleeding, is not provided. These observations underscore the need for a multidisciplinary collaboration among cardiologists, anesthesiologists, hematologists and surgeons to reach this goal. The present document is an update on practical recommendations for standardizing management of antithrombotic therapy management in patients treated with coronary stents (Surgery After Stenting 2) in various types of surgery according to the predicted individual risk of thrombotic complications against the anticipated risk of surgical bleeding complications. Cardiologists defined the thrombotic risk using a "combined ischemic risk" approach, while surgeons classified surgeries according to their inherent hemorrhagic risk. Finally, a multidisciplinary agreement on the most appropriate antithrombotic treatment regimen in the perioperative phase was reached for each surgical procedure.

AB - Perioperative management of antithrombotic therapy in patients treated with coronary stents undergoing surgery remains poorly defined. Importantly, surgery represents a common reason for premature treatment discontinuation, which is associated with an increased risk in mortality and major adverse cardiac events. However, maintaining antithrombotic therapy to minimize the incidence of perioperative ischemic complications may increase the risk of bleeding complications. Although guidelines provide some recommendations with respect to the perioperative management of antithrombotic therapy, these have been largely developed according to the thrombotic risk of the patient and a definition of the hemorrhagic risk specific to each surgical procedure, key to defining the trade-off between ischemia and bleeding, is not provided. These observations underscore the need for a multidisciplinary collaboration among cardiologists, anesthesiologists, hematologists and surgeons to reach this goal. The present document is an update on practical recommendations for standardizing management of antithrombotic therapy management in patients treated with coronary stents (Surgery After Stenting 2) in various types of surgery according to the predicted individual risk of thrombotic complications against the anticipated risk of surgical bleeding complications. Cardiologists defined the thrombotic risk using a "combined ischemic risk" approach, while surgeons classified surgeries according to their inherent hemorrhagic risk. Finally, a multidisciplinary agreement on the most appropriate antithrombotic treatment regimen in the perioperative phase was reached for each surgical procedure.

U2 - 10.1016/j.jcin.2017.10.051

DO - 10.1016/j.jcin.2017.10.051

M3 - Review article

C2 - 29519377

VL - 11

SP - 417

EP - 434

JO - JACC: Cardiovascular Interventions

JF - JACC: Cardiovascular Interventions

SN - 1936-8798

IS - 5

ER -