To the Editor: The recent article by Barthwal and Herman highlights the problem of late stent thrombosis in a patient with a drug-eluting stent (DES) undergoing non-cardiac surgery (NCS).1 While the authors stated that clopidogrel therapy was ceased preoperatively and not restarted postoperatively, they did not say whether or not aspirin therapy was continued. In addition, emphasis was not placed on the role the surgical procedure played in this adverse cardiac outcome.
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- 1 Gold Coast Hospital, Gold Coast, QLD.
- 2 Griffith University, Gold Coast, QLD.
- 1. Barthwal R, Herman BA. Very late stent thrombosis after discontinuation of clopidogrel therapy. Med J Aust 2008; 189: 229-230. <eMJA full text> <MJA full text>
- 2. Grines C, Bonow R, Casey D, et al. AHA/ACC/SCAI/ACS/ADA Science Advisory: prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents. Circulation 2007; 115: 813-818.
- 3. Cassot PG, Delabays A, Spahan D. Perioperative antiplatelet therapy: the case for continuing therapy in patients at risk of myocardial infarction. Br J Anaesth 2007; 99: 316-328.
- 4. Emmanouil S. Perioperative management of patients with coronary stents. J Am Coll Cardiol 2007; 49: 2145-2150.
- 5. Rade J, Hogue C. Noncardiac surgery for patients with coronary artery stents. Anesthesiology 2008; 109: 573-575.