Perioperative dual antiplatelet therapy for patients undergoing spine surgery soon after drug eluting stent placement.
Surg Neurol Int
california; santa monica; psjhc
Background: Performing emergent spinal surgery within 6 months of percutaneous placement of drug-eluting coronary stent (DES) is complex. The risks of spinal bleeding in a "closed space" must be compared with the risks of stent thrombosis or major cardiac event from dual antiplatelet therapy (DAPT) interruption.
Methods: Eighty relevant English language papers published in PubMed were reviewed in detail.
Results: Variables considered regarding surgery in patients on DAPT for DES included: (1) surgical indications, (2) percutaneous cardiac intervention (PCI) type (balloon angioplasty vs. stenting), (3) stent type (drug-eluting vs. balloon mechanical stent), and (4) PCI to noncardiac surgery interval. The highest complication rate was observed within 6 weeks of stent placement, this corresponds to the endothelialization phase. Few studies document how to manage patients with critical spinal disease warranting operative intervention within 6 months of their PCI for DES placement.
Conclusion: The treatment of patients requiring urgent or emergent spinal surgery within 6 months of undergoing a PCI for DES placement is challenging. As early interruption of DAPT may have catastrophic consequences, we hereby proposed a novel protocol involving stopping clopidogrel 5 days before and aspirin 3 days before spinal surgery, and bridging the interval with a reversible P2Y12 inhibitor until surgery. Moreover, postoperatively, aspirin could be started on postoperative day 1 and clopidogrel on day 2. Nevertheless, this treatment strategy may not be appropriate for all patients, and multidisciplinary approval of perioperative antiplatelet therapy management protocols is essential.
Neurosciences (Brain & Spine)
Peeters, Sophie M; Nagasawa, Daniel; Gaonkar, Bilwaj; Niu, Tianyi; Tucker, Alexander; Attiah, Mark; Babayan, Diana; Moreland, Natalie; Yang, Isaac; Press, Marcela Calfon; and Macyszyn, Luke, "Perioperative dual antiplatelet therapy for patients undergoing spine surgery soon after drug eluting stent placement." (2021). Articles, Abstracts, and Reports. 5140.