Withholding anti platelet therapy in those with coronary stents

Withholding anti platelet therapy in those with coronary stents

Five to ten percent of patients who have been implanted a coronary stent will need a surgery within the next two years. Early surgery carries a risk of coronary stent thrombosis with sequelae ranging from myocardial infarction to sudden cardiac death while withholding anti-platelet agents for surgery. As per the 2007 American College of Cardiology / American Heart Association guidelines, surgery within six weeks is considered as early surgery for bare metal stents (BMS) and within one year for drug eluting stents (DES). Up to twelve percent may need early surgery in case of BMS and up to 47% in case of DES (larger number in latter group possibly because of the longer ‘early’ time window). During the ‘early’ period, stents are not well endothelialized and run the risk of stent thrombosis while interrupting anti-platelet therapy.

With newer generation drug eluting stents, the incidence of stent thrombosis is much lower.