Perioperative stent thrombosis

Percutaneous coronary intervention with stent placement is one of the most frequently performed procedures in the western world. Patients with coronary stents need to be on dual antiplatelet therapy in order to minimize the risk of stent thrombosis. When these patients undergo surgical procedures, the risk of stent thrombosis needs to be balanced against the risk of bleeding in the perioperative period. We review the definition of stent thrombosis and its incidence, the perioperative risk factors associated with stent thrombosis and with bleeding owing to dual antiplatelet therapy. Based on the published guidelines, we also review different management strategies of patients with coronary stents, or who develop stent thrombosis in the perioperative period. We also present some future perioperative management strategies, illustrating the possibilities and challenges offered by newer antiplatelet agents.