Skip Navigation

British Journal of Anaesthesia 2007 98(5):560-574; doi:10.1093/bja/aem089
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow CME/CE:
Take the course for this article:
 BJA: May 2007
Right arrow E-Letters: Submit a response to the article
Right arrow E-letters: View responses
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (15)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Howard-Alpe, G. M.
Right arrow Articles by Sear, J. W.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Howard-Alpe, G. M.
Right arrow Articles by Sear, J. W.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?


© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Coronary artery stents and non-cardiac surgery

G. M. Howard-Alpe1,*,{dagger}, J. de Bono2, L. Hudsmith2, W. P. Orr3, P. Foex1 and J. W. Sear1

1 Nuffield Department of Anaesthetics and
2 Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK
3 Department of Cardiology, Royal Berkshire Hospital, London Road, Reading RG1 5AN, UK

* Corresponding author: Nuffield Department of Anaesthetics, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK. E-mail: georgina.howard-alpe{at}nda.ox.ac.uk

The utility of interventional cardiology has developed significantly over the last two decades with the introduction of coronary angioplasty and stenting, with the associated antiplatelet medications. Acute coronary stent occlusion carries a high morbidity and mortality, and the adoption of therapeutic strategies for prophylaxis against stent thrombosis has major implications for surgeons and anaesthetists involved in the management of these patients in the perioperative period. Currently, there is limited published information to guide the clinician in the optimal care of patients who have had coronary stents inserted when they present for non-cardiac surgery. This review examines the available literature on the perioperative management of these patients. A number of key issues are identified: the role of surgery vs percutaneous coronary intervention for coronary revascularization in the preoperative period; the different types of coronary stents currently available; the emerging issues related to drug-eluting stents; the pathophysiology of coronary stent occlusion; and the recommended antiplatelet regimes that the patient with a coronary stent will be receiving. The role of preoperative platelet function testing is also discussed, and the various available tests are listed.

Appropriate management by all the clinicians involved with patients with coronary stents undergoing a variety of non-cardiac surgical procedures is essential to avoid a high incidence of postoperative cardiac mortality and morbidity. The review examines the evidence available for the perioperative strategies aimed at reducing adverse outcomes in a number of different clinical scenarios.

Keywords: anaesthetic techniques, regional; coronary stenosis, drug therapy; platelet aggregation inhibitors, therapeutic use; stents; surgery, non-cardiac

{dagger} Declaration of interest. Dr Georgina Howard-Alpe was supported by an unrestricted grant from Venner Capital SA.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 Eur Heart JHome page
Authors/Task Force Members, D. Poldermans, J. J. Bax, E. Boersma, S. De Hert, E. Eeckhout, G. Fowkes, B. Gorenek, M. G. Hennerici, B. Iung, et al.
Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery: The Task Force for Preoperative Cardiac Risk Assessment and Perioperative Cardiac Management in Non-cardiac Surgery of the European Society of Cardiology (ESC) and endorsed by the European Society of Anaesthesiology (ESA)
Eur. Heart J., November 2, 2009; 30(22): 2769 - 2812.
[Full Text] [PDF]

Home page
 Br J AnaesthHome page
K. F. J. Ng, J.-C. Lawmin, S. F. Tsang, W. M. Tang, and K. Y. Chiu
Value of a single preoperative PFA-100(R) measurement in assessing the risk of bleeding in patients taking cyclooxygenase inhibitors and undergoing total knee replacement
Br. J. Anaesth., June 1, 2009; 102(6): 779 - 784.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
K. N. Saxena, S. Kumar, B. Taneja, and P. Gaba
Non-cardiac surgery 2 weeks after percutaneous cardiac intervention
Br. J. Anaesth., May 1, 2009; 102(5): 719 - 720.
[Full Text] [PDF]

Home page
 Br J AnaesthHome page
A. Evans and R. G. Davies
A new type of coronary artery stent
Br. J. Anaesth., March 1, 2009; 102(3): 435 - 436.
[Full Text] [PDF]

Home page
 Arch SurgHome page
J. M. O'Riordan, R. J. Margey, G. Blake, and P. R. O'Connell
Antiplatelet Agents in the Perioperative Period
Arch Surg, January 1, 2009; 144(1): 69 - 76.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
L. T. Newsome, R. S. Weller, J. C. Gerancher, M. A. Kutcher, and R. L. Royster
Coronary Artery Stents: II. Perioperative Considerations and Management
Anesth. Analg., August 1, 2008; 107(2): 570 - 590.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
G. Godet, Y. Le Manach, F. Lesache, S. Perbet, and P. Coriat
Drug-eluting stent thrombosis in patients undergoing non-cardiac surgery: is it always a problem?
Br. J. Anaesth., April 1, 2008; 100(4): 472 - 477.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
A. Bhatia, H. Nicholls, and G. Howard-Alpe
Coronary artery stents and non-cardiac surgery
Br. J. Anaesth., January 1, 2008; 100(1): 137 - 138.
[Full Text] [PDF]

Home page
 Br J AnaesthHome page
C. W. Kotze, R. S. Kong, N. P. Hutchinson, C. M. Harper, S. W. Yusuf, and G. Howard-Alpe
Coronary artery stents and non-cardiac surgery
Br. J. Anaesth., January 1, 2008; 100(1): 138 - 139.
[Full Text] [PDF]

Home page
 Br J AnaesthHome page
R. E. Self and G. M. Howard-Alpe
Regional anaesthesia in patients treated with aspirin and clopidogrel
Br. J. Anaesth., October 1, 2007; 99(4): 594 - 596.
[Full Text] [PDF]

Home page
 Br J AnaesthHome page
P.-G. Chassot, A. Delabays, and D. R. Spahn
Perioperative antiplatelet therapy: the case for continuing therapy in patients at risk of myocardial infarction
Br. J. Anaesth., September 1, 2007; 99(3): 316 - 328.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
S. Bengeri and G. Howard-Alpe
Coronary artery stents and non-cardiac surgery
Br. J. Anaesth., August 1, 2007; 99(2): 299 - 300.
[Full Text] [PDF]

E-letters:

Read all E-letters

Tiny Ticking Time Bombs in the patients hearts.
sheshagiri bengeri
British Journal of Anaesthesia, 11 May 2007 [Full text]
Response to e-letter "Ticking time bombs in patients hearts
Georgina M Howard-Alpe
British Journal of Anaesthesia, 21 May 2007 [Full text]
Regional anaesthesia in patients treated with aspirin and clopidogrel
Robert E Self
British Journal of Anaesthesia, 29 May 2007 [Full text]
Response to "Regional anaesthesia in patients treated with aspirin and clopidogrel".
Georgina M Howard-Alpe
British Journal of Anaesthesia, 11 Jul 2007 [Full text]
Coronary artery stents and non-cardiac surgery.
C W Kotze, et al.
British Journal of Anaesthesia, 19 Jul 2007 [Full text]
Perioperative management of antiplatelet therapy
Anuj Bhatia, et al.
British Journal of Anaesthesia, 14 Aug 2007 [Full text]
Re: Perioperative management of antiplatelet therapy
Georgina M Howard-Alpe
British Journal of Anaesthesia, 5 Oct 2007 [Full text]
Re: Coronary artery stents and non-cardiac surgery.
Georgina M Howard-Alpe
British Journal of Anaesthesia, 5 Oct 2007 [Full text]

Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.