Cardiac Stent
Anesthesia Implications
Anesthesia Implications
The big questions surrounding stents are usually aimed at how long surgery should be delayed after a stent is placed and what should be done when emergency surgery is necessary. Below you can find the answers to these questions:
How Long Should Elective Surgery Be Delayed?
Bare Metal Stents (BMS): 30-45 days
examples: “R Stent”, Genous Bio-engineered R Stent, BxVelocity, Express 2 Matrix stent, Vision, MP35N Driver Stent, Omega BMS
Drug-Eluting Stents (DES), 1st Generation: 1 year
examples: Paclitaxel eluting stents (PES), Sirolimus eluting stents (SES)
Drug-Eluting Stents (DES), 2nd Generation: 6 months
examples: Everolimas eluting stents (EES), Zotarolimus eluting stents (ZES)
Why Delay Surgery? – Patients must remain on dual antiplatelet therapy (DAPT) for the times listed above. While on DAPT, the patient runs a high risk of excessive bleeding perioperatively.
Which Drugs Are Used for Dual Antiplatelet Therapy? – Aspirin + Adenosine Diphosphate (ADP) receptor antagonists OR P2Y12 Inhibitors – Clopidogrel (Plavix), Prasugrel (Effient), Ticagrelor (Brillinta), Ticlopidine (Ticlid)
Emergency Surgery – Continue aspirin throughout the perioperative period
Butterworth. Morgan & Mikhail’s Clinical Anesthesiology. 2013. p. 395
Fleisher. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. 2014
Windecker. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). 2014