Double jeopardy: balance between bleeding and stent thrombosis with prolonged dual antiplatelet therapy after drug-eluting stent implantation

Cardiovasc Revasc Med. 2006 Jul-Sep;7(3):155-8. doi: 10.1016/j.carrev.2006.04.001.

Abstract

Prolonged dual antiplatelet therapy with aspirin and clopidogrel is mandatory after drug-eluting stent (DES) implantation because of potential increase risk of stent thrombosis compared to bare-metal stents. As more DES are being implanted, many of these patients will undergo non-cardiac surgery whilst on antiplatelet therapy. The optimal management of perioperative antiplatelet therapy is not well established. The risk of excessive bleeding associated with antiplatelet therapy needs to be balanced against the risk of stent thrombosis with interruption of antiplatelet therapy on a case-to-case basis.

Publication types

  • Review

MeSH terms

  • Aspirin / adverse effects
  • Aspirin / therapeutic use
  • Blood Vessel Prosthesis Implantation
  • Clinical Trials as Topic
  • Clopidogrel
  • Coated Materials, Biocompatible / therapeutic use*
  • Coronary Disease / surgery
  • Graft Occlusion, Vascular / epidemiology
  • Graft Occlusion, Vascular / etiology*
  • Graft Occlusion, Vascular / prevention & control*
  • Humans
  • Platelet Aggregation Inhibitors / adverse effects
  • Platelet Aggregation Inhibitors / therapeutic use*
  • Postoperative Hemorrhage / chemically induced*
  • Postoperative Hemorrhage / epidemiology
  • Risk Factors
  • Stents / adverse effects*
  • Ticlopidine / adverse effects
  • Ticlopidine / analogs & derivatives
  • Ticlopidine / therapeutic use
  • Time Factors

Substances

  • Coated Materials, Biocompatible
  • Platelet Aggregation Inhibitors
  • Clopidogrel
  • Ticlopidine
  • Aspirin