This case highlights the risk of late occlusive thrombosis in drug-eluting stents following acute withdrawal of dual antiplatelet therapy, even more than 2 years post-placement.
Perioperative clopidogrel withdrawal may precipitate late DES thrombosis; leaves open optimal bridging strategies for surgery.
This study presents the case of intraoperative thrombosis of a right coronary drug-eluting stent and subsequent right heart ischemia more than 2 years poststent placement and after recent withdrawal of clopidogrel therapy. Dual antiplatelet therapy had been continued uninterrupted since placement until 7 days prior to surgery when clopidogrel was stopped. This case highlights the emerging evidence that drug-eluting stents are susceptible to late occlusive thrombosis on acute withdrawal of antiplatelet therapy. Right heart ischemia resolved with rapid intraoperative management and emergent cardiac catheterization. This emphasizes the necessity of immediate availability to cardiac interventional facilities, which can influence outcomes.
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Murray et al. (2011) studied this question.
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