Perioperative Management of Patients on Clopidogrel (Plavix) Undergoing Major Lung Resection DuyKhanh P. Ceppa, MD, Ian J. Welsby, MBBS, Tracy Y. Wang, MD, Mark W. Onaitis, MD, Betty C. Tong, MD, David H. Harpole, MD, Thomas A. D'Amico, MD, Mark F. Berry, MD The Annals of Thoracic Surgery Volume 92, Issue 6, Pages 1971-1976 (December 2011) DOI: 10.1016/j.athoracsur.2011.07.052 Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions
Fig 1 Algorithm for perioperative clopidogrel management. Patients who are at lower risk of in-stent thrombosis (coronary stenting more than 3 years before surgery, bare-metal stent [BMS] more than 1 year with no history of acute myocardial infarction [AMI]) proceed to surgery on aspirin (acetylsalicylic acid [ASA])after a 5-day period of clopidogrel cessation. Patients who are at higher risk of in-stent thrombosis (drug-eluting stent [DES] less than 12 months, drug-eluting stent more than 12 months who have high-risk clinical factors—renal insufficiency, critical location, off-label placement of coronary stent) are bridged to surgery with an eptifibatide infusion after 3 days of clopidogrel cessation. (DM = diabetes mellitus; EF = ejection fraction; PCI = percutaneous coronary intervention.) The Annals of Thoracic Surgery 2011 92, 1971-1976DOI: (10.1016/j.athoracsur.2011.07.052) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions