Perioperative management of antiplatelet agents in patients with coronary stents: recommendations of a French Task Force.

Correspondence Perioperative management of antiplatelet agents in patients with coronary stents: recommendations of a French Task Force Editor—Following recent articles relating to perioperative antiplatelet drugs (APs) in the British Journal of Anaesthesia, 1–3 we thought it would be of interest to share with you the recommendations of a recent working party in France which addressed the use of APs in patients with coronary stents. Currently, high-level evidence is lacking in the literature in support for strong recommendations on the perioperative use of APs. The lack of evidence is particularly striking when considering patients with coronary stents, especially drug-eluting stents. This is a problem because an increasing number of patients with stents and receiving a combination of APs (aspirin and clopidogrel) are candidates for an inva-sive procedure or surgery. The risk of bleeding and/or thrombosis while maintaining or withdrawing AP treatment in these patients has not been assessed. A multidisciplinary group of experts (cardiologists, haematologists, surgeons and anaesthesiologists) met in December 2005 under the auspices of the French Society of Anaesthesiology and Intensive Care (SFAR) to review the state-of-the-art in the field and to produce recommendations on appropriate clinical practice. In view of the paucity of evidence-based data, the recommendations are based in large part on agreement among the members of the task force. A consensus was not reached on all points; at times, more than one management option was proposed. The recommendations are not meant to be evidence-based guidelines but a guide to practitioners in their routine practice. Recommendations 1. Combination AP treatment should be maintained for at least 4–6 weeks after placement of a bare metal stent and at least 6–12 months after placement of a drug-eluting stent. 4 2. If AP treatment is well managed, the risk of acute thrombosis is independent of stent type (drug-eluting or not). Withdrawing APs is a major risk factor for thrombosis for all types of stent and especially for late stent thrombosis in the case of drug-eluting stents, 5 6 treatment should therefore be long term. However, one or both APs may need to be withdrawn in order to perform an invasive diagnostic or surgical procedure. 7 8 The frequency of stent thrombosis in this situation has not been established for drug-eluting stents as only isolated clinical cases have been reported in the literature without any data on the number of cases with no perioperative thrombotic complications. 9–11 3. Whether a stent …