약물 용출 스텐트 시술후 비 심장 수술(non-cardiac surgery) 시 환자 관리
Post-PCI management with DES for minor and major non-cardiac surgery
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
In-stent restenosis has been reduced significantly after introduction of drug eluting stent (DES). But concern of long-term safety has emerged because of inappropriate neointimal coverage over stent related with cytotoxic drug and polymer. Recently, non-cardiac surgery after DES implantation is increasing and use of anti-platelet agent during operation might be problematic. Non-cardiac surgery might increase the risk of stent thrombosis, which was related with myocardial infarction and death, particularly in DES. Preoperative discontinuation of dual-antiplatelet therapy (DAT) and early surgery after stent implantation have been well known factors of perioperative stent thrmbosis. Thus, current guideline for anti-platelet therapy in non-cardiac surgery was established in patients after balloon angioplasty and bare metal stent based on duration of DAT according to the period of complete endothelization and neointimal growth after stent implantation. But, there are controversies and little evidence in DES for timing and use of DAT to reduce the stent thrombosis in non-cardiac surgery. Therefore, I reviewed the existing data about stent thrombosis after noncardiac surgery, the impact of delay from surgery and discontinuation of DAT. Based on these published data, I suggested recommendations for patients who require noncardiac surgery after DES. (Korean J Med 75:392-397, 2008)
Abstract
In-stent restenosis has been reduced significantly after introduction of drug eluting stent (DES). But concern of long-term safety has emerged because of inappropriate neointimal coverage over stent related with cytotoxic drug and polymer. Recently, non-cardiac surgery after DES implantation is increasing and use of anti-platelet agent during operation might be problematic. Non-cardiac surgery might increase the risk of stent thrombosis, which was related with myocardial infarction and death, particularly in DES. Preoperative discontinuation of dual-antiplatelet therapy (DAT) and early surgery after stent implantation have been well known factors of perioperative stent thrmbosis. Thus, current guideline for anti-platelet therapy in non-cardiac surgery was established in patients after balloon angioplasty and bare metal stent based on duration of DAT according to the period of complete endothelization and neointimal growth after stent implantation. But, there are controversies and little evidence in DES for timing and use of DAT to reduce the stent thrombosis in non-cardiac surgery. Therefore, I reviewed the existing data about stent thrombosis after noncardiac surgery, the impact of delay from surgery and discontinuation of DAT. Based on these published data, I suggested recommendations for patients who require noncardiac surgery after DES. (Korean J Med 75:392-397, 2008)
참고문헌 (22)
- Bourassa MG, "Clinical, physiologic, anatomic and procedural factors predictive of restenosis after percutaneous transluminal coronary angioplasty", J Am Coll Cardiol, 18, pp.368~376 (1991)
- Hirshfeld JW, Jr, "Restenosis after coronary angioplasty: a multivariate statistical model to relate lesion and procedure variables to restenosis. The M-HEART Investigators", J Am Coll Cardiol, 18, pp.647~656 (1991)
- Fischman DL, "A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. Stent Restenosis Study Investigators", N Engl J Med, 331, pp.496~501 (1994)
- Carrozza JP, Jr, "Angiographic and clinical outcome of intracoronary stenting: immediate and long-term results from a large single-center experience", J Am Coll Cardiol, 20, pp.328~337 (1992)
- Morice MC, "A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization", N Engl J Med, 346, pp.1773~1780 (2002)
- Moses JW, "Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery", N Engl J Med, 349, pp.1315~1323 (2003)
- Stone GW, "polymer-based, paclitaxel-eluting stent in patients with coronary artery disease", N Engl J Med, 350, pp.221~231 (2004)
- Grines CL, "Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians", Circulation, 115, pp.813~818 (2007)
- McFadden EP, "Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy", Lancet, 364, pp.1519~1521 (2004)
- Wilson SH, "Clinical outcome of patients undergoing non-cardiac surgery in the two months following coronary stenting", J Am Coll Cardiol, 42, pp.234~240 (2003)
- Yan BP, "Double jeopardy: balance between bleeding and stent thrombosis with prolonged dual antiplatelet therapy after drug-eluting stent implantation", Cardiovasc Revasc Med, 7, pp.155~158 (2006)
- Vicenzi MN, "Coronary artery stenting and non-cardiac surgery--a prospective outcome study", Br J Anaesth, 96, pp.686~693 (2006)
- Schouten O, "Noncardiac surgery after coronary stenting: early surgery and interruption of antiplatelet therapy are associated with an increase in major adverse cardiac events", J Am Coll Cardiol, 49, pp.122~124 (2007)
- Kim HL, "Stent-related cardiac events after non-cardiac surgery: drug-eluting stent vs. bare metal stent", Int J Cardiol, 123, pp.353~354 (2008)
- "Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients", BMJ, 324, pp.71~86 (2002)
- Yusuf S, "Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation", N Engl J Med, 345, pp.494~502 (2001)
- Ernst A, "Effect of routine clopidogrel use on bleeding complications after transbronchial biopsy in humans", Chest, 129, pp.734~737 (2006)
- Chassot PG, "Perioperative antiplatelet therapy: the case for continuing therapy in patients at risk of myocardial infarction", Br J Anaesth, 99, pp.316~328 (2007)
- Cutlip DE, "Stent thrombosis in the modern era: a pooled analysis of multicenter coronary stent clinical trials", Circulation, 103, pp.1967~1971 (2001)
- Fleisher LA, "ACC", AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology, Circulation, pp.2007, 116[DOI]
- Samama CM, "Preoperative nonsteroidal antiinflammatory agents as substitutes for aspirin: already too late?", Anesthesiology, 106, pp.205~206 (2007)
- Broad L, "Successful management of patients with a drugeluting coronary stent presenting for elective, non-cardiac surgery", Br J Anaesth, 98, pp.19~22 (2007)