Perioperative antiplatelet therapy: the case for continuing therapy in patients at risk of myocardial infarction P.-G. Chassot, A. Delabays, D.R. Spahn

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Date of download: 11/12/2016 Copyright © The American College of Cardiology. All rights reserved. From: Efficacy and Safety of Dual Antiplatelet Therapy.

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Perioperative antiplatelet therapy: the case for continuing therapy in patients at risk of myocardial infarction P.-G. Chassot, A. Delabays, D.R. Spahn British Journal of Anaesthesia Volume 99, Issue 3, Pages 316-328 (September 2007) DOI: 10.1093/bja/aem209 Copyright © 2007 British Journal of Anaesthesia Terms and Conditions

Fig 1 Twelve- month outcome of patients with stents receiving clopidogrel or not (reproduced with permission from Mehta71). British Journal of Anaesthesia 2007 99, 316-328DOI: (10.1093/bja/aem209) Copyright © 2007 British Journal of Anaesthesia Terms and Conditions

Fig 2 Twenty-four month outcome of patients with BMS and DES, with or without clopidogrel (reproduced with permission from Eisenstein28). British Journal of Anaesthesia 2007 99, 316-328DOI: (10.1093/bja/aem209) Copyright © 2007 British Journal of Anaesthesia Terms and Conditions

Fig 3 Algorithm for preoperative management of patients under antiplatelet therapy. MI, myocardial infarction; ACS, acute coronary syndrome; PAD, peripheral arterial disease; PCI, percutaneous coronary intervention; BMS, bare metal stent; DES, drug eluting stent. *High-risk stents: long (>36 mm), proximal, overlapping, or multiple stents implantation, stents in chronic total occlusions, stents in small vessels or bifurcated lesions. **Examples of low-risk situations: >3 months after BMS, stroke, uncomplicated MI, PCI without stenting. ***Risk of bleeding in closed space: intracranial neurosurgery, intra-medullary canal surgery, posterior eye chamber ophthalmic surgery. In these situations, the risk/benefit ratio of upholding vs withdrawing aspirin must be evaluated for each case individually; in case of aspirin upholding, early postoperative re-institution is important. British Journal of Anaesthesia 2007 99, 316-328DOI: (10.1093/bja/aem209) Copyright © 2007 British Journal of Anaesthesia Terms and Conditions