Practice alert for the perioperative management of patients with coronary artery stents: a report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters.

PRACTICE Alerts are consensus-based reports that address specific aspects of patient management, patient care, and patient safety. This Practice Alert reviews published recommendations that address the perioperative management of surgical patients with recently implanted coronary artery stents. The intent of the Alert is to provide the anesthesiologist with information about (1) the increased risk of perioperative myocardial infarction and death in these patients and (2) the relation between antiplatelet therapy and acute perioperative stent thrombosis. A major concern after successful coronary artery stent placement is the potential for acute stent thrombosis, with subsequent myocardial infarction and death. To prevent stent thrombosis in the nonsurgical setting, cardiologists typically recommend dual antiplatelet therapy after coronary stent placement. Dual therapy typically consists of a combination of aspirin and thienopyridine. Premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents who are scheduled to undergo surgery increases the risk of stent thrombosis, myocardial infarction, and death. This opinion was issued as a 2007 Science Advisory by the American Heart Association (AHA), American College of Cardiology (ACC), Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association. This opinion is also supported by the ACC/AHA Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery.