180 likes | 327 Views
LINEE GUIDA E FLOW CHART OPERATIVA PER LA SOSPENSIONE “SICURA” DELLA TERAPIA ANTIAGGREGANTE IN PREPARAZIONE DELL’INTERVENTO. CHIRURGIA MAGGIORE. Risk of early surgery after stent implantation. Early surgery after stent implantation: High risk after discontinuation of dual antiplatelet therapy.
E N D
LINEE GUIDA E FLOW CHART OPERATIVA PER LA SOSPENSIONE “SICURA” DELLA TERAPIA ANTIAGGREGANTE IN PREPARAZIONE DELL’INTERVENTO CHIRURGIA MAGGIORE
Early surgery after stent implantation: High risk after discontinuation of dual antiplatelet therapy
VALUTAZIONE RISCHIO/BENEFICIO ED IMPATTO CLINICO trombosi emorragia DES su TC/IVA Ultimo vaso Neurochirurgia Chirurgia Oftalmica
STRATIFICAZIONE PER RISCHI TROMBOSI/EMORRAGIA RISCHIO EMORRAGICO RISCHIO TROMBOTICO Adattata da Riddell et al, Circulation 2007; 116: e378-e382
Clopidogrel bridging protocol Inclusion criteria • Consecutive candidates for urgent major (CV or non-CV) surgery • or eye surgery in whom dual antiplatelet therapy could not be withdrawn as the time of surgery was within 6 months of the placement of any DES, or within one year of the placement of any DES under conditions considered to be at higher risk for stent thrombosis: • stent implantation due to an ACS, • diabetes, • renal insufficiency or • severe left ventricular dysfunction, • stents placed in LMCA, proximal LAD (or equivalent), bifurcation
- 8 cardiac surgery, 6 urinary tract , 10 gastroenteric surgery, 5 other surgery- No MACE ( death, MI, stroke )- 1 TIMI major bleeding- 8 patients required blood transfusion (6 before surgery for anemia, 2 post-operatively for proctorrhagy ). Global experience : 30 patients
LIMITAZIONI DEL PROTOCOLLO ‘NIGUARDA’ • Utilizzo ‘off label’ del tirofiban • Persiste rischio emorragico non trascurabile • Incertezze associazione eparina