Does an individualized antiplatelet strategy using GPIIb-IIIa inhibitors improve outcomes in patients with perioperative stent thrombosis?
An individualized antiplatelet strategy using a short-acting intravenous GPIIb-IIIa inhibitor may be beneficial for managing perioperative stent thrombosis following premature discontinuation of dual antiplatelet therapy.
Surgery often requires the interruption of standard dual antiplatelet therapy using aspirin and clopidogrel. Here, we present three patients who underwent surgery and suffered from a perioperative stent thrombosis associated with premature discontinuation of dual antiplatelet therapy. Although there are missing evidence-based data and key guidelines, we suggest that patients who undergo surgery after coronary stenting may benefit from an individualized perioperative antiplatelet management strategy. After premature dual antiplatelet therapy discontinuation, when the bridging of the preoperative time interval with the use of a short acting intravenous glycoprotein (GP) IIb-IIIa inhibitor including a platelet function testing has been missed and a coronary stent thrombosis has occurred, the patients should be administered a GPIIb-IIIa inhibitor for 12–24 hours, followed by aspirin for one day and a dual antiplatelet treatment after 24–48 hours. Our patients benefited from this individualized practical approach.
Bigalke et al. (2010) studied this question.