BERKELEY, CA (UroToday.com) - About 1.8 million Americans will undergo a percutaneous coronary intervention (PCI) and receive one or more intracoronary stents, annually.[1]
Current guidelines recommend 1 month of dual antiplatelet therapy for bare-metal coronary stents and 1 year of dual antiplatelet therapy for drug-eluting coronary stents.[2] The extensive use of dual antiplatelet therapy presents a signifi cant dilemma for the perioperative management of this population undergoing genitourinary surgery.
Bare-metal stents (BMS) are thin expandable strut devices constructed from stainless steel alloys that scaffold open segments of atherosclerotic coronary arteries. In all, 25 – 30% of patients developed stent re-stenosis within the first year after BMS implantation requiring vessel revascularisation, either via repeat stenting or surgery.[3] In 2003, the USA Food and Drug Administration (FDA) approved the use of drug-eluting stents (DES), which are coated with a polymer that releases anti-proliferative and anti-inflammatory drugs that have been shown to decrease stent re-stenosis by nearly 70%. Although DES markedly decrease intimal hyperplasia, they also simultaneously increase the time required for stent endothelialisation [3,4] and therefore require a much longer period of dual anti-platelet therapy to reduce the risk of stent thrombosis. ..View or save the full text Mini Review as a .pdf file .
| What’s known on the subject? and What does the study add? Withdrawal of dual antiplatelet therapy before the recommended, 12 months for drug-eluting stents and 1 month for bare-metal stents increases the rate of major adverse coronary events and mortality. However, in those undergoing surgery the risk of bleeding is increased substantially for those on antiplatelet agents. Successful management in patients with coronary stents who must undergo elective or nonelective urological surgery should be a multidisciplinary decision. This article reviews the literature and recommends a protocol for clinical management of patients undergoing urological procedures after coronary stent placement. |
Angela D. Gupta, Michael Streiff,* Jon Resar,† and Mark Schoenberg
Departments of Urology, *Hematology and †Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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