Stent coronarico e chirurgia

La gestione perioperatoria della terapia antiaggregante nel paziente portatore di stent coronarico candidato a intervento chirurgico

Translated title of the contribution: Coronary stenting and surgery: Perioperative management of antiplatelet therapy in patients undergoing surgery after coronary stent implantation

Roberta Rossini, Ezio Bramucci, Battistina Castiglioni, Stefano De Servi, Corrado Lettieri, Maddalena Lettino, Giuseppe Musumeci, Luigi Oltrona Visconti, Emanuela Piccaluga, Stefano Savonitto, Daniela Trabattoni, Francesca Buffoli, Dominick J. Angiolillo, Francesco Bovenzi, Alberto Cremonesi, Marino Scherillo, Giulio Guagliumi, Piersilvio Gerometta, Alessandro Parolari, Gianlorenzo Dionigi & 36 others Luigi Boni, Enrico Guffanti, Federico Biglioli, Giada Beltramini, Luigi Valdatta, Luca Devalle, Andrea Droghetti, Antonio Bozzani, Paolo Ravelli, Claudio Crescini, Giovanni Staurenghi, Sergiomaria Gaini, Pietro Scarone, Luca Francetti, Stefano Corbella, Fabio D'Angelo, Andrea Comel, Franco Gadda, Luca Salvi, Antonio Castelli, Emanuela Menozzi, Stefano Bartoli, Luigi Presenti, Mauro Longoni, Marco Soncini, Giancarlo Spinzi, Maurizio Vecchi, Giuseppe Ferronato, Enrico Robotti, Davide Dell'Amore, Carlo Setacci, Gianluigi Melotti, Paolo Cherubino, Francesco Rocco, Franco Servadei, Giampietro Creperio

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

The management of antiplatelet therapy in patients with coronary stents undergoing surgery is a growing clinical problem and often represents a matter of debate between cardiologists and surgeons. It has been estimated that about 4-8% of patients undergoing coronary stenting need to undergo surgery within the next year. Surgery represents one of the most common reasons for premature antiplatelet therapy discontinuation, which is associated with a significant increase in mortality and major adverse cardiac events, in particular stent thrombosis. In addition, surgery confers an additional risk of perioperative cardiac ischemic events, being high in these patients because of the pro-inflammatory and pro-thrombotic effects of surgery. Current international guidelines recommend to postpone non-urgent surgery for at least 6 weeks after bare metal stent implantation and for 6-12 months after drug-eluting stent implantation. However, these recommendations provide little support with regard to managing antiplatelet therapy in the perioperative phase in case of urgent operations and/or high hemorrhagic risk. Furthermore, ischemic and hemorrhagic risk is not defined in detail on the basis of clinical and procedural characteristics. Finally, guidelines shared with cardiologists and surgeons are lacking. The present consensus document provides practical recommendations on the management of antiplatelet therapy in the perioperative period in patients with coronary stents undergoing surgery. Cardiologists and surgeons contributed equally to its creation. An ischemic risk stratification has been provided on the basis of clinical and procedural data. All surgical interventions have been defined on the basis of the hemorrhagic risk. A consensus on the most appropriate antiplatelet regimen in the perioperative phase has been reached on the basis of the ischemic and hemorrhagic risk. Dual antiplatelet therapy should not be withdrawn for surgery at low bleeding risk, whereas aspirin should be continued perioperatively in the majority of surgical operations. In the event of interventions at high risk for both bleeding and ischemic events, when oral antiplatelet therapy withdrawal is required, perioperative treatment with short-acting intravenous glycoprotein IIb/IIIa inhibitors (tirofiban or eptifibatide) should be considered.

Original languageItalian
Pages (from-to)528-551
Number of pages24
JournalGiornale Italiano di Cardiologia
Volume13
Issue number7-8
DOIs
Publication statusPublished - Jul 2012

Fingerprint

Stents
tirofiban
Therapeutics
Guidelines
Hemorrhage
Platelet Glycoprotein GPIIb-IIIa Complex
Perioperative Period
Drug-Eluting Stents
Aspirin
Thrombosis
Metals
Mortality
Cardiologists
Surgeons

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Stent coronarico e chirurgia : La gestione perioperatoria della terapia antiaggregante nel paziente portatore di stent coronarico candidato a intervento chirurgico. / Rossini, Roberta; Bramucci, Ezio; Castiglioni, Battistina; De Servi, Stefano; Lettieri, Corrado; Lettino, Maddalena; Musumeci, Giuseppe; Visconti, Luigi Oltrona; Piccaluga, Emanuela; Savonitto, Stefano; Trabattoni, Daniela; Buffoli, Francesca; Angiolillo, Dominick J.; Bovenzi, Francesco; Cremonesi, Alberto; Scherillo, Marino; Guagliumi, Giulio; Gerometta, Piersilvio; Parolari, Alessandro; Dionigi, Gianlorenzo; Boni, Luigi; Guffanti, Enrico; Biglioli, Federico; Beltramini, Giada; Valdatta, Luigi; Devalle, Luca; Droghetti, Andrea; Bozzani, Antonio; Ravelli, Paolo; Crescini, Claudio; Staurenghi, Giovanni; Gaini, Sergiomaria; Scarone, Pietro; Francetti, Luca; Corbella, Stefano; D'Angelo, Fabio; Comel, Andrea; Gadda, Franco; Salvi, Luca; Castelli, Antonio; Menozzi, Emanuela; Bartoli, Stefano; Presenti, Luigi; Longoni, Mauro; Soncini, Marco; Spinzi, Giancarlo; Vecchi, Maurizio; Ferronato, Giuseppe; Robotti, Enrico; Dell'Amore, Davide; Setacci, Carlo; Melotti, Gianluigi; Cherubino, Paolo; Rocco, Francesco; Servadei, Franco; Creperio, Giampietro.

In: Giornale Italiano di Cardiologia, Vol. 13, No. 7-8, 07.2012, p. 528-551.

Research output: Contribution to journalArticle

Rossini, R, Bramucci, E, Castiglioni, B, De Servi, S, Lettieri, C, Lettino, M, Musumeci, G, Visconti, LO, Piccaluga, E, Savonitto, S, Trabattoni, D, Buffoli, F, Angiolillo, DJ, Bovenzi, F, Cremonesi, A, Scherillo, M, Guagliumi, G, Gerometta, P, Parolari, A, Dionigi, G, Boni, L, Guffanti, E, Biglioli, F, Beltramini, G, Valdatta, L, Devalle, L, Droghetti, A, Bozzani, A, Ravelli, P, Crescini, C, Staurenghi, G, Gaini, S, Scarone, P, Francetti, L, Corbella, S, D'Angelo, F, Comel, A, Gadda, F, Salvi, L, Castelli, A, Menozzi, E, Bartoli, S, Presenti, L, Longoni, M, Soncini, M, Spinzi, G, Vecchi, M, Ferronato, G, Robotti, E, Dell'Amore, D, Setacci, C, Melotti, G, Cherubino, P, Rocco, F, Servadei, F & Creperio, G 2012, 'Stent coronarico e chirurgia: La gestione perioperatoria della terapia antiaggregante nel paziente portatore di stent coronarico candidato a intervento chirurgico', Giornale Italiano di Cardiologia, vol. 13, no. 7-8, pp. 528-551. https://doi.org/10.1714/1114.12251
Rossini, Roberta ; Bramucci, Ezio ; Castiglioni, Battistina ; De Servi, Stefano ; Lettieri, Corrado ; Lettino, Maddalena ; Musumeci, Giuseppe ; Visconti, Luigi Oltrona ; Piccaluga, Emanuela ; Savonitto, Stefano ; Trabattoni, Daniela ; Buffoli, Francesca ; Angiolillo, Dominick J. ; Bovenzi, Francesco ; Cremonesi, Alberto ; Scherillo, Marino ; Guagliumi, Giulio ; Gerometta, Piersilvio ; Parolari, Alessandro ; Dionigi, Gianlorenzo ; Boni, Luigi ; Guffanti, Enrico ; Biglioli, Federico ; Beltramini, Giada ; Valdatta, Luigi ; Devalle, Luca ; Droghetti, Andrea ; Bozzani, Antonio ; Ravelli, Paolo ; Crescini, Claudio ; Staurenghi, Giovanni ; Gaini, Sergiomaria ; Scarone, Pietro ; Francetti, Luca ; Corbella, Stefano ; D'Angelo, Fabio ; Comel, Andrea ; Gadda, Franco ; Salvi, Luca ; Castelli, Antonio ; Menozzi, Emanuela ; Bartoli, Stefano ; Presenti, Luigi ; Longoni, Mauro ; Soncini, Marco ; Spinzi, Giancarlo ; Vecchi, Maurizio ; Ferronato, Giuseppe ; Robotti, Enrico ; Dell'Amore, Davide ; Setacci, Carlo ; Melotti, Gianluigi ; Cherubino, Paolo ; Rocco, Francesco ; Servadei, Franco ; Creperio, Giampietro. / Stent coronarico e chirurgia : La gestione perioperatoria della terapia antiaggregante nel paziente portatore di stent coronarico candidato a intervento chirurgico. In: Giornale Italiano di Cardiologia. 2012 ; Vol. 13, No. 7-8. pp. 528-551.
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T2 - La gestione perioperatoria della terapia antiaggregante nel paziente portatore di stent coronarico candidato a intervento chirurgico

AU - Rossini, Roberta

AU - Bramucci, Ezio

AU - Castiglioni, Battistina

AU - De Servi, Stefano

AU - Lettieri, Corrado

AU - Lettino, Maddalena

AU - Musumeci, Giuseppe

AU - Visconti, Luigi Oltrona

AU - Piccaluga, Emanuela

AU - Savonitto, Stefano

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AU - Buffoli, Francesca

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AU - Bovenzi, Francesco

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AU - Scherillo, Marino

AU - Guagliumi, Giulio

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AU - Parolari, Alessandro

AU - Dionigi, Gianlorenzo

AU - Boni, Luigi

AU - Guffanti, Enrico

AU - Biglioli, Federico

AU - Beltramini, Giada

AU - Valdatta, Luigi

AU - Devalle, Luca

AU - Droghetti, Andrea

AU - Bozzani, Antonio

AU - Ravelli, Paolo

AU - Crescini, Claudio

AU - Staurenghi, Giovanni

AU - Gaini, Sergiomaria

AU - Scarone, Pietro

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AU - Corbella, Stefano

AU - D'Angelo, Fabio

AU - Comel, Andrea

AU - Gadda, Franco

AU - Salvi, Luca

AU - Castelli, Antonio

AU - Menozzi, Emanuela

AU - Bartoli, Stefano

AU - Presenti, Luigi

AU - Longoni, Mauro

AU - Soncini, Marco

AU - Spinzi, Giancarlo

AU - Vecchi, Maurizio

AU - Ferronato, Giuseppe

AU - Robotti, Enrico

AU - Dell'Amore, Davide

AU - Setacci, Carlo

AU - Melotti, Gianluigi

AU - Cherubino, Paolo

AU - Rocco, Francesco

AU - Servadei, Franco

AU - Creperio, Giampietro

PY - 2012/7

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N2 - The management of antiplatelet therapy in patients with coronary stents undergoing surgery is a growing clinical problem and often represents a matter of debate between cardiologists and surgeons. It has been estimated that about 4-8% of patients undergoing coronary stenting need to undergo surgery within the next year. Surgery represents one of the most common reasons for premature antiplatelet therapy discontinuation, which is associated with a significant increase in mortality and major adverse cardiac events, in particular stent thrombosis. In addition, surgery confers an additional risk of perioperative cardiac ischemic events, being high in these patients because of the pro-inflammatory and pro-thrombotic effects of surgery. Current international guidelines recommend to postpone non-urgent surgery for at least 6 weeks after bare metal stent implantation and for 6-12 months after drug-eluting stent implantation. However, these recommendations provide little support with regard to managing antiplatelet therapy in the perioperative phase in case of urgent operations and/or high hemorrhagic risk. Furthermore, ischemic and hemorrhagic risk is not defined in detail on the basis of clinical and procedural characteristics. Finally, guidelines shared with cardiologists and surgeons are lacking. The present consensus document provides practical recommendations on the management of antiplatelet therapy in the perioperative period in patients with coronary stents undergoing surgery. Cardiologists and surgeons contributed equally to its creation. An ischemic risk stratification has been provided on the basis of clinical and procedural data. All surgical interventions have been defined on the basis of the hemorrhagic risk. A consensus on the most appropriate antiplatelet regimen in the perioperative phase has been reached on the basis of the ischemic and hemorrhagic risk. Dual antiplatelet therapy should not be withdrawn for surgery at low bleeding risk, whereas aspirin should be continued perioperatively in the majority of surgical operations. In the event of interventions at high risk for both bleeding and ischemic events, when oral antiplatelet therapy withdrawal is required, perioperative treatment with short-acting intravenous glycoprotein IIb/IIIa inhibitors (tirofiban or eptifibatide) should be considered.

AB - The management of antiplatelet therapy in patients with coronary stents undergoing surgery is a growing clinical problem and often represents a matter of debate between cardiologists and surgeons. It has been estimated that about 4-8% of patients undergoing coronary stenting need to undergo surgery within the next year. Surgery represents one of the most common reasons for premature antiplatelet therapy discontinuation, which is associated with a significant increase in mortality and major adverse cardiac events, in particular stent thrombosis. In addition, surgery confers an additional risk of perioperative cardiac ischemic events, being high in these patients because of the pro-inflammatory and pro-thrombotic effects of surgery. Current international guidelines recommend to postpone non-urgent surgery for at least 6 weeks after bare metal stent implantation and for 6-12 months after drug-eluting stent implantation. However, these recommendations provide little support with regard to managing antiplatelet therapy in the perioperative phase in case of urgent operations and/or high hemorrhagic risk. Furthermore, ischemic and hemorrhagic risk is not defined in detail on the basis of clinical and procedural characteristics. Finally, guidelines shared with cardiologists and surgeons are lacking. The present consensus document provides practical recommendations on the management of antiplatelet therapy in the perioperative period in patients with coronary stents undergoing surgery. Cardiologists and surgeons contributed equally to its creation. An ischemic risk stratification has been provided on the basis of clinical and procedural data. All surgical interventions have been defined on the basis of the hemorrhagic risk. A consensus on the most appropriate antiplatelet regimen in the perioperative phase has been reached on the basis of the ischemic and hemorrhagic risk. Dual antiplatelet therapy should not be withdrawn for surgery at low bleeding risk, whereas aspirin should be continued perioperatively in the majority of surgical operations. In the event of interventions at high risk for both bleeding and ischemic events, when oral antiplatelet therapy withdrawal is required, perioperative treatment with short-acting intravenous glycoprotein IIb/IIIa inhibitors (tirofiban or eptifibatide) should be considered.

KW - Aspirin

KW - Clopidogrel

KW - Coronary heart disease

KW - Stent

KW - Surgery

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