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Coronary stents: elective surgery delay

After coronary artery stenting, patients are maintained on dual antiplatelet therapy (DAPT). When presenting for elective surgery, these medications are often held to minimize bleeding risk intraoperatively. The ideal timeframe to wait after stenting before proceeding with elective surgery is guideline based, and therefore does change periodically. The current guidelines are put out jointly by the American College of Cardiology and the American Heart Association (ACC/AHA).

The core guidelines for appropriate time interval for elective surgery after stenting are to wait 1 month after placement of a bare metal stent and 6 months after DES. However if the surgery is deemed urgent enough where the risk of delay is greater than the risk of in-stent thrombosis, it can be acceptable to proceed after 3 months after DES.

If the surgery is emergent or urgent to the point that it cannot wait the recommended period, then ideally aspirin should be continued, and the P2Y12 inhibitor either held or continued based on the risk of bleeding during the procedure. If the P2Y12 inhibitor is held, then it should be restarted as soon as safely possible postoperatively.

Other References

  1. August 15, 2019: Keys to the Cart ACC/AHA Guidelines: Stents Link
  2. 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease Link