Look into Stent Options Before undergoing Catheterization

I will like to elaborate on a point I made in my last blog.  I want to talk about the issue of patients who are undergoing cardiac catheterization for preoperative evaluation.  These patients may or may not have evidence for cardiac disease either by stress testing or symptoms.  What is done after the cath is critical and the need for non-cardiac surgery must be thoroughly discussed and analyzed before proceeding with any revascularization by stenting or coronary artery bypass surgery.

 A study concerning this issue was just published in the journal Heart 2009; 95:1303-1308.  It is titled Non-Cardiac Surgery and Antiplatelet Therapy Following Coronary Artery Stenting.  This article reports a Meta analysis of this common clinical scenario.  A Meta analysis is not a study.  It is a statistical analysis of like studies that are melded together to seek out common similarities and differences in treatments.  Although they often don’t fully answer questions, they point us in directions to ask better questions and can lead to meaningful dialogue.

This report covers 50,000 patients and finds that undergoing non-cardiac surgery while on low dose aspirin i.e. 81 mg. increases the risk of minor bleeding by 50%.  There is no change in major bleeding except in prostate and neurosurgery procedures. 

The use of Plavix during surgery increases the risk of major bleeding.

In previous blogs, I have discussed the use of these agents after stenting.  If you have a non-drug stent, the current recommendations are to take aspirin and Plavix for a minimum of a month but if possible for one year.  If you have a drug stent, the recommendation is to take aspirin and Plavix for one year.  If you were stented for a myocardial infarction or unstable angina then the recommendations are one year regardless of what stent you have implanted.

In my patients depending on what type of surgery is needed, I often do not repair the coronary blockages until after surgery.  Many operations can be done safely with aspirin and beta-blocking drugs such as Toprol and atenolol.  There are many options but if not discussed this clinical scenario can lead to disaster.  It is always necessary to thoroughly discuss all aspects of your medical condition with all your doctors.

Tags: cardiac catheterization, Coronary Artery Bypass Surgery, Coronary Artery Stenting, non-cardiac surgery, Plavix
Posted in Aortic Aneurysms /Stents / Grafts, Cardiac Surgery, Coronary Artery Disease | No Comments »