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

Rossini, Roberta; Tarantini, Giuseppe; Musumeci, Giuseppe; Masiero, Giulia; Barbato, Emanuele; Calabrò, Paolo; Capodanno, Davide; Leonardi, Sergio; Lettino, Maddalena; Limbruno, Ugo; Menozzi, Alberto; Marchese, U O Alfredo; Saia, Francesco; Valgimigli, Marco; Ageno, Walter; Falanga, Anna; Corcione, Antonio; Locatelli, Alessandro; Montorsi, Marco; Piazza, Diego; ... (2018). A Multidisciplinary Approach on the Perioperative Antithrombotic Management of Patients With Coronary Stents Undergoing Surgery: Surgery After Stenting 2. JACC. Cardiovascular Interventions, 11(5), pp. 417-434. Elsevier 10.1016/j.jcin.2017.10.051

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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.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Valgimigli, Marco

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1876-7605

Publisher:

Elsevier

Language:

English

Submitter:

Amanda Valle

Date Deposited:

03 Aug 2018 08:27

Last Modified:

03 Aug 2018 08:27

Publisher DOI:

10.1016/j.jcin.2017.10.051

PubMed ID:

29519377

Uncontrolled Keywords:

anticoagulant therapy antiplatelet therapy atrial fibrillation bleeding stent surgery thrombosis

BORIS DOI:

10.7892/boris.119027

URI:

https://boris.unibe.ch/id/eprint/119027

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