Discussions for Module 9: Peri-Operative Cardiac Risk Reduction

Questions are answered by module authors: W. Scott Beattie MD and Sharon Davies MD.

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Question:

Do you have a hospital policy to continue ASA on ALL stented patients except neuro, retinal surgery and possibly TURPs? If a stented patient takes Plavix do you insist on a documented focused discussion with a cardiologist if Plavix is stopped for any reason? Please note that I mean ANY KIND of stent and ANY time since placement? Would you insist on postponement of a non-EMERGENT procedure if you think that the patient who stopped one or both drugs should have continued them and no immediate cardiology opinion is available ( even if this upsets your surgeon)? If the answer is NO to any of the questions please substantiate. Thank you.

SP 10/16/2010 8:59:17 PM


Dr. Beattie replies:

The University Health Network does not have a hospital policy, instead there are guidelines for patients with prior PCA. This is also a subject of an on going peer reviewed research project.If the patient has a Bare metal Stent for less than 6 months we discuss with interventional cardiology and if scheduled for elective surgery  our preference is to delay the surgery, if after a full discussion the surgery can not be delayed then we would insist on ASA at a minimum. Plavix continued if if is not high transfusion risk surgery. We routinely do Carotid endarterectomies on PLAVIX The time line is 1 year for a  drug eluted stent. Please NOTE  both are guidelines for care NOT POLICY.I have no problem cancelling or delaying ELECTIVE surgery in a patient would or should be on an antiplatelet agent  In my opinion , All patients who have PCI , of any duration should remain in ASA

 


 

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