Thu18November0253AM 7

A 72-year-old man is reviewed in the pre-assessment clinic. He is scheduled for a total hip replacement in a week.

The patient had a myocardial infarction seven months ago and had an angioplasty where a drug eluting stent was inserted. The patient is taking clopidogrel 75 mg and aspirin 75 mg daily.

Which one of the following is the most appropriate course of action?

(Please select 1 option)

Continue both drugs and proceed as planned

Stop the clopidogrel but continue aspirin and proceed Incorrect answer selected

Stop both drugs and proceed as planned

Stop the aspirin but continue clopidogrel and proceed

Postpone surgery for a year from the date of insertion of the stent This is the correct answer

Explanation

Thrombosis of a drug-eluting stent is associated with high morbidity (42%) and mortality (71%). For this reason, dual antiplatelet therapy (usually aspirin and clopidogrel) is continued for at least twelve months following the insertion of this type of stent.

The risk of stent thrombosis (ST) is increased in the perioperative setting and is associated with discontinuation of antiplatelet drugs. The risk of ST has to be balanced with the risk of bleeding because antiplatelet therapy has not been stopped. Ideally elective surgery should be postponed for twelve months when it is considered safe to stop clopidogrel and continue with aspirin. This patient is scheduled for an elective procedure.

Multidisciplinary discussion between surgeon, anaesthetist and cardiologist on how to manage antiplatelet therapy and timing of surgery should always take place.

Reference:

Abualsaud AO, Eisenberg MJ. Perioperative management of patients with drug-eluting stents. JACC Cardiovasc Interv. 2010;3:131-42.

DeVile MP, Foëx P. Antiplatelet drugs, coronary stents, and non-cardiac surgery Contin Educ Anaesth Crit Care Pain. 2010;10:187-191.

Answer Statistics

1

2%

2

34%

3

2%

4

4%

5

60%

Times answered: 248