#Guideliner for stenting trial#

The 2011 AHA/ACC Guideline for Percutaneous Coronary Intervention highlights several points regarding the relationship between coronary anatomy and stent placement. 30įurthermore, current perioperative management of antiplatelet therapy needs to reflect new information on perioperative in-stent thrombosis.

#Guideliner for stenting trial#

30 However, the PeriOperative ISchemic Evaluation 2 trial excluded patients who received a BMS less than 6 weeks before surgery or a DES less than 1 yr before surgery.

20 Of note, the PeriOperative ISchemic Evaluation 2 trial, involving a total of 10,010 patients (4.3% of whom had undergone previous coronary artery stenting), observed that prophylactic administration of aspirin before surgery and throughout the early postsurgical period, in noncardiac surgery patients, had no significant effect on the rate of a composite of death or nonfatal MI but was associated with an increase in the risk of major bleeding. 28, 29 However, in another study of the optimal timing of noncardiac surgery versus coronary artery stent placement, the risk of severe, “life-threatening” bleeding (defined as fatal bleeding, intracranial bleeding, or bleeding requiring surgical intervention or transfusion of ≥4 units of blood products) was reported to be 4% with single antiplatelet therapy and 21% with DAPT.

In two studies on the optimal timing of noncardiac surgery after BMS and DES placement, the continuation of DAPT at the time of surgery did not increase the risk of major surgical bleeding. 23 A landmark analysis is a well-established observational method used for comparing time-to-event outcome between groups that are determined during the study follow-up period. In addition, this landmark analysis found that the highest risk for all MACE after DAPT cessation occurred in the first 6 months after coronary stent placement. This result is consistent with others’ findings that higher risk patients are more likely to have DAPT continued and such practice is not completely protective against MACE. Moreover, 74% of MACE occurred when patients were on DAPT. There was no association between brief DAPT interruption for surgery and a MACE. The overall incidence of DAPT cessation in the 24-month follow-up was 57%, and a brief interruption occurred in 10% of patients. 23 Three categories of cessation were assessed: (1) physician-recommended discontinuation (2) brief interruption (for surgery) and (3) disruption due to patient noncompliance or complication (bleeding). 10Ī recent multicenter study reported the incidence and outcome of DAPT cessation after coronary artery stent implantation. 9 While the concomitant use of an NSAID and aspirin may increase the risk of a myocardial infarction (MI), the effect on in-stent thrombosis remains unknown. 8 The American Heart Association has also broadly discouraged the use of both selective (COX-2) and nonselective (COX-1 and COX-2) inhibiting NSAIDs in patients with risk factors for coronary heart disease. The US FDA has also issued a black box warning on the use of an NSAID in the immediate postoperative period after coronary artery bypass graft surgery. This timing reduces the risk that the NSAID will prevent the inhibitory effect of aspirin on the platelet COX pathway. The US Food and Drug Administration (FDA) has thus recommended that patients on aspirin (except if enteric coated) and an NSAID should take the NSAID more than 8 h before aspirin or at least 30 min after the aspirin. 7 Furthermore, 72% of patients had a recurrent ischemic event while on both drugs.

It has been reported that in patients with a history of stroke, taking aspirin concomitantly with ibuprofen or naproxen, the platelet inhibition effect of aspirin was lost. A question that commonly arises is the concurrent use of aspirin and a nonsteroidal antiinflammatory drug (NSAID) in patients with a coronary artery stent.