Drug-Eluting Stent Thrombosis During Perioperative
Period
- Author(s)
- Sang Jae RHEE; Kyeong Ho YUN; Sang Rok LEE; Jei-Keon CHAE; Chang-Wook NAM; Dong-Hwan JUN; Jin-Won JEONG
- Keimyung Author(s)
- Nam, Chang Wook
- Department
- Dept. of Internal Medicine (내과학)
- Journal Title
- International Heart Journal
- Issued Date
- 2008
- Volume
- 49
- Issue
- 2
- Abstract
- SUMMARY
Recently, the number of patients in whom a drug-eluting stent (DES) has recently
been implanted and who need to undergo surgery or the most invasive procedure is
increasing. However, there are limited data about the risk of perioperative thrombosis of
DES. We evaluated the incidence and the risk factors of DES thrombosis during the perioperative
period.
Between January 2002 and December 2006, 141 patients who underwent surgery
requiring discontinuation of a dual antiplatelet agent within 12 months of DES implantation
were enrolled in one of the 3 study hospitals. We reviewed the clinical and procedural
characteristics of the patients who developed stent thrombosis during the perioperative
period.
Stent thrombosis occurred in 7 cases (5.0%). The clinical outcomes of the patients
with stent thrombosis were death in 5 cases and nonfatal MI in 2 cases. The patients with
stent thrombosis were found to be older (64.2 ± 9.7 versus 71.7 ± 6.0 years, P = 0.045),
to use a Taxus stent more frequently (36.6 versus 85.7%, P = 0.014), and to have a more
prolonged period of discontinuation of clopidogrel (12.7 ± 10.0 versus 51.3 ± 33.2 days,
P = 0.022) than the patients without stent thrombosis. Multivariate analysis revealed that
7 days or longer discontinuation of clopidogrel (OR 12.8, 95% CI 1.3-121.6, P = 0.021)
and the use of a Taxus stent (OR 10.2, 95% CI 1.1-95.7, P = 0.043) were significant independent
predictors of stent thrombosis during the perioperative period.
A prolonged period of discontinuation of clopidogrel was associated with higher risk
of stent thrombosis during the perioperative period. An earnest effort to continue antiplatelet
therapy throughout the perioperative period can minimize the risk of stent
thrombosis. (Int Heart J 2008; 49: 135-142)
Key words: Stent thrombosis, Drug-eluting stents, Perioperative care
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