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Dual antiplatelet therapy and non-cardiac surgery: evolving issues and anesthetic implications

DC Field Value Language
dc.contributor.author소사라-
dc.contributor.author송종욱-
dc.contributor.author심재광-
dc.date.accessioned2018-11-07T16:40:23Z-
dc.date.available2018-11-07T16:40:23Z-
dc.date.issued2017-
dc.identifier.issn2005-6419-
dc.identifier.urihttps://ir.ymlib.yonsei.ac.kr/handle/22282913/165087-
dc.description.abstractDual antiplatelet therapy (DAPT) consisting of aspirin plus a P2Y12 inhibitor (clopidogrel, prasugrel, or ticagrelor) is imperative for the treatment of acute coronary syndrome, particularly during the re-endothelialization period after percutaneous coronary intervention (PCI). When patients undergo surgery during this period, the consequences of stent thrombosis are far more serious than those of bleeding complications, except in cases of intracranial surgery. The recommendations for perioperative DAPT have changed with emerging evidence regarding the improved efficacy of non-first-generation drug (everolimus, zotarolimus)-eluting stents (DES). The mandatory interval of 1 year for elective surgery after DES implantation was shortened to 6 months (3 months if surgery cannot be further delayed). After this period, it is generally recommended that the P2Y12 inhibitor be stopped for the amount of time necessary for platelet function recovery (clopidogrel 5-7 days, prasugrel 7-10 days, ticagrelor 3-5 days), and that aspirin be continued during the perioperative period. In emergent or urgent surgeries that cannot be delayed beyond the recommended period after PCI, proceeding to surgery with continued DAPT should be considered. For intracranial procedures or other selected surgeries in which increased bleeding risk may also be fatal, cessation of DAPT (possibly with continuation or minimized interruption [3-4 days] of aspirin) with bridge therapy using short-acting, reversible intravenous antiplatelet agents such as cangrelor (P2Y12 inhibitor) or glycoprotein IIb/IIIa inhibitors (tirofiban, eptifibatide) may be contemplated. Such a critical decision should be individually tailored based on consensus among the anesthesiologist, cardiologist, surgeon, and patient to minimize both ischemic and bleeding risks.-
dc.description.statementOfResponsibilityopen-
dc.formatapplication/pdf-
dc.languageKorean, English-
dc.publisher대한마취과학회-
dc.relation.isPartOfKOREAN JOURNAL OF ANESTHESIOLOGY-
dc.rightsCC BY-NC-ND 2.0 KR-
dc.rightshttps://creativecommons.org/licenses/by-nc-nd/2.0/kr/-
dc.titleDual antiplatelet therapy and non-cardiac surgery: evolving issues and anesthetic implications-
dc.typeArticle-
dc.contributor.collegeCollege of Medicine (의과대학)-
dc.contributor.departmentDept. of Anesthesiology and Pain Medicine (마취통증의학교실)-
dc.contributor.googleauthorJong Wook Song-
dc.contributor.googleauthorSarah Soh-
dc.contributor.googleauthorJae-Kwang Shim-
dc.identifier.doi10.4097/kjae.2017.70.1.13-
dc.contributor.localIdA01960-
dc.contributor.localIdA02060-
dc.contributor.localIdA02205-
dc.relation.journalcodeJ01963-
dc.identifier.eissn2005-7563-
dc.identifier.pmid28184261-
dc.subject.keywordAcute coronary syndrome-
dc.subject.keywordAntiplatelet therapy-
dc.subject.keywordPercutaneous coronary intervention-
dc.subject.keywordSurgery-
dc.contributor.alternativeNameSoh, Sa Rah-
dc.contributor.alternativeNameSong, Jong Wook-
dc.contributor.alternativeNameShim, Jae Kwang-
dc.contributor.affiliatedAuthor소사라-
dc.contributor.affiliatedAuthor송종욱-
dc.contributor.affiliatedAuthor심재광-
dc.citation.volume70-
dc.citation.number1-
dc.citation.startPage13-
dc.citation.endPage21-
dc.identifier.bibliographicCitationKOREAN JOURNAL OF ANESTHESIOLOGY, Vol.70(1) : 13-21, 2017-
dc.identifier.rimsid60273-
dc.type.rimsART-
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers

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