SURGERY EARLY AFTER DES IMPLANTATION THERAPEUTIC IMPLICATIONS It depends on which surgery Giuseppe Biondi-Zoccai Division of Cardiology, University of Turin, gbiondizoccai@gmail.com 20/10/2010 - 16.05-16.15

Timing from DAT withdrawal and ST Artang et al, AJC 2007

Temporal risk from PCI to surgery Cruden et al, Circ Cardiovasc Interv 2010

Predictors of stent thrombosis Grines et al, Circ 2007

Ischemic risk of surgery Fleisher et al, Circ 2007

Bleeding risk of surgery O’Riordan et al, Arch Surg 2009

ESC Guidelines Wijns et al, EHJ 2010

Balancing bleeding & ischemic risk Heart, Lung and Circulation 2010

Management of patients needing surgery Di Minno et al, Intern Emerg Med 2009

Bridging therapy Savonitto et al, BJA 2010

Bridging therapy Savonitto et al, BJA 2010

What to do if bleeding occurs? O’Riordan et al, Arch Surg 2009

Continue DAT in all but few cases Take home messages Individualize treatment depending on bleeding risk, ischemic risk and surgeon’s skills Continue DAT in all but few cases If DAT cannot be enforced, use bridging therapy plus aspirin

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