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首页> 外文期刊>Therapeutic advances in cardiovascular disease. >Late and very late drug-eluting stent thrombosis in the immediate postoperative period after antiplatelet withdrawal: a retrospective study
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Late and very late drug-eluting stent thrombosis in the immediate postoperative period after antiplatelet withdrawal: a retrospective study

机译：回顾性研究：抗血小板药物撤除后术后即刻晚期和晚期药物洗脱支架血栓形成

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Late (31–360 days after deployment) and very late (360 days after deployment) stent thrombosis is a feared complication after drug-eluting stent (DES) deployment. The American College of Cardiology/American Heart Association guidelines recommend dual antiplatelet therapy for 12 months due to the lack of protection beyond this period in randomized trials. The perioperative period is a unique state of generalized hypercoagulability which can predispose people to DES thrombosis when combined with the rebound hypercoagulable effect of antiplatelet withdrawal. A retrospective chart review was performed to detect incidences of late and very late postoperative DES thrombosis after elective noncardiac surgery. Only definite and probable cases of stent thrombosis were included. All cases were analyzed for patient demographics, comorbidities, type of surgery, intervention history, preoperative antiplatelets management, postoperative course and outcome. A total of six patients with prior DES deployment (10–42 months earlier, average 30 months) developed DES thrombosis (five very late and one late) in the immediate postoperative period. All patients had stable coronary artery disease and were cleared for surgery (intermediate cardiac risk surgery) by their cardiologist. In all patients, antiplatelets were discontinued 4–7 days (average 5.6 days) prior to surgery to minimize operative bleeding. Five of six patients developed ST-segment elevation myocardial infarction. Half of the patients had simultaneous two-vessel DES thrombosis and two cases had single vessel thrombosis. Three patients developed ventricular fibrillation and cardiac arrest. One-third of the patients died during the index hospitalization. Coronary thrombectomy and angioplasty was successful in the remaining four cases. The incidence of postoperative late and very late DES thrombosis among all patients undergoing noncardiac surgery who were older than 40 years was 0.006%. Caution should be exercised when attempting to withdraw antiplatelets preoperatively in patients with DES even when the recommended 12-month period of dual antiplatelet therapy (DAPT) has elapsed. The significant morbidity and mortality of this complication warrants further research to study the ideal perioperative management of antiplatelets in patients with prior DES deployment over 1 year who are still receiving DAPT.
机译：药物洗脱支架（DES）部署后，晚期（部署后31-360天）和非常晚期（部署后> 360天）是令人担忧的并发症。美国心脏病学会/美国心脏协会指南建议采用双重抗血小板治疗，为期12个月，因为在此随机试验中，超过该时间段缺乏保护。围手术期是普遍性高凝状态的一种独特状态，当与抗血小板停药的反弹性高凝作用相结合时，可使人们易于发生DES血栓形成。进行回顾性图表审查，以检测选择性非心脏手术后术后晚期和非常晚期DES血栓的发生率。仅包括明确的和可能的支架血栓病例。分析所有病例的患者人口统计学，合并症，手术类型，干预史，术前抗血小板管理，术后病程和结局。共有6例先前使用DES的患者（较早前10-42个月，平均30个月）在术后立即发生DES血栓形成（五个很晚，一个很晚）。所有患者均患有稳定的冠状动脉疾病，并且由心脏病专家批准进行了手术（中度心脏风险手术）。在所有患者中，在手术前4-7天（平均5.6天）停用抗血小板药物，以最大程度地减少手术出血。 6例患者中有5例发展为ST段抬高型心肌梗塞。一半的患者同时发生两支血管DES血栓形成，两例发生单血管血栓形成。三例患者出现心室纤颤和心脏骤停。三分之一的患者在指数住院期间死亡。在其余四例中，冠状动脉血栓切除术和血管成形术成功。在所有40岁以上的接受非心脏手术的患者中，术后晚期和晚期DES血栓形成的发生率为0.006％。即使在推荐的12个月双重抗血小板治疗（DAPT）期过后，尝试在DES患者术前撤回抗血小板时也应谨慎行事。该并发症的高发病率和死亡率值得进一步研究，以研究仍在接受DAPT且先前DES部署超过1年的患者的抗血小板理想围手术期管理。

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