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Pronlonging coronary stent life and balancing perioperative risk: More studies needed.
- Dr Sumit Kumar Jha, Dr Ashok Kumar BP, SHO Anaesthetics, Dublin. (18 May 2006)
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Dr Sumit Kumar Jha, Senior House Officer, Anaesthetics. Pinderfields General Hospital NHS Trust, Wakefield., Dr Ashok Kumar BP, SHO Anaesthetics, Dublin.
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I read with interest the well written article by Dr Spahn and colleagues on coronary stents and perioperative anti-platelet regimen: dilemma of bleeding and stent thrombosis. As the authors point out, currently, over 90% of all percutaneous coronary interventions (PCIs) involve placement of stents and thus bringing interventions to prolong stent life to the forefront. As an anaesthetist, I frequently come across patients who are on dual therapy: ADP receptor antagonist: Clopidogrel and the usual Aspirin. Most of these patients would have strong family histories of Ischaemic Heart disease. The figures quoted in cases of non-cardiac surgery for patients receiving dual anti-platelet therapy to have a 25–40% increased risk of bleeding; seems to be overstretched. The authors also suggest that bleeding in non-cardiac surgery is not a common or important complication when compared with the incidence of cardiac events and that there is a strong case for a study in patients on dual anti-platelet treatment who have recently undergone PCI and now require non-cardiac surgery. This study should compare a combined aspirin and clopidogrel therapy with aspirin alone. We look forward to continuing with locally acceptable algorithms and also the outcomes of similar studies in future. Conflict of Interest:None declared |
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