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Recommendations for Management of Antiplatelet Therapy in Patients Undergoing Elective Noncardiac Surgery After Coronary Stent Implantation

Huang, Pei-Hsiu MD*; Croce, Kevin J. MD, PhD*†; Bhatt, Deepak L. MD, MPH*†; Resnic, Frederic S. MD, MSc*

Critical Pathways in Cardiology: December 2012 - Volume 11 - Issue 4 - p 177–185
doi: 10.1097/HPC.0b013e31826c53cd

Patients commonly undergo noncardiac surgical procedures after implantation of a coronary stent. In the case where surgery cannot be deferred until completing the minimum duration of dual antiplatelet therapy, the Brigham and Women’s Hospital Cardiac Catheterization Laboratory recommends using a glycoprotein IIb/IIIa bridging protocol to minimize the risk of perioperative ischemic events. We discuss our algorithm for managing antiplatelet agents, including the newer agents, prasugrel and ticagrelor, in patients undergoing noncardiac surgery after coronary stenting and present our glycoprotein IIb/IIIa bridging strategy along with a review of the relevant pharmacodynamic and clinical evidence.

From the *Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School; and the Department of Medicine, Cardiovascular Division, VA Boston Healthcare System, Boston, MA.

Reprints: Frederic S. Resnic, MD, MSc, Cardiac Catheterization Laboratory, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.