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URGENT ORTHOPEDIC SURGERY WITHIN FOUR WEEKS OF A COMPLEX PCI
1174 JACC April 5, 2016 Volume 67, Issue 13
FIT Clinical Decision Making URGENT ORTHOPEDIC SURGERY WITHIN FOUR WEEKS OF A COMPLEX PCI Poster Contributions Poster Area, South Hall A1 Sunday, April 03, 2016, 9:45 a.m.-10:30 a.m. Session Title: FIT Clinical Decision Making: Acute Coronary Syndrome, Stable Ischemic Heart Disease, Interventional Cardiology, Vascular Medicine Abstract Category: Acute Coronary Syndromes Presentation Number: 1185-322 Authors: Sameer Chadha, Abhinav Saxena, Jignesh Patel, Jacob Shani, Bilal Malik, Maimonides Medical Center, Brooklyn, NY, USA
Background: There is paucity of data regarding optimal management of dual antiplatelet therapy (DAPT) in patients requiring urgent or emergent surgery. We present a challenging case where in urgent orthopedic surgery was required within four weeks of a complex PCI with drug eluting stents (DES).
Case: Sixty one year old female with history of triple vessel coronary artery disease and high risk for coronary artery bypass surgery underwent multi-vessel complex percutaneous coronary intervention (PCI) in 2013. She recently presented with non ST elevation myocardial infarction needing repeat PCI with DES to the Left Anterior Descending (LAD) and Obtuse Marginal second branch (OM2). She was discharged on aspirin and clopidogrel. Due to a mechanical fall, patient developed femur fracture within one week of PCI. She was initially managed conservatively for two weeks but owing to the nature of the fracture a decision to operate was taken and cardiology was consulted for management of dual antiplatelet therapy in the perioperative period. Decision Making: Current American College of Cardiology (ACC) and American Heart Association (AHA) guidelines recommend avoidance of surgery within twelve months of DES placement. Interruption of DAPT is associated with high risk of in-stent thrombosis. Our patient required urgent surgery within weeks of complex PCI. DAPT was continued in the perioperative period and intraoperative platelet transfusion was used to control excessive bleeding. This patient received a total of one unit of platelets. Patient recovered well from the surgery without thrombotic stent complications. This strategy was used for two more patients over the past five years with good outcomes without any stent thrombosis. Conclusions: This case demonstrates that in patients with recent DES, discontinuation of antiplatelet agents may not be required in the perioperative period. Continuation of dual antiplatelet therapy and utilization of intra-operative platelet transfusion if required to control excess bleeding appears to be a promising approach and warrants further investigation.
FIT Clinical Decision Making URGENT ORTHOPEDIC SURGERY WITHIN FOUR WEEKS OF A COMPLEX PCI Poster Contributions Poster Area, South Hall A1 Sunday, April 03, 2016, 9:45 a.m.-10:30 a.m. Session Title: FIT Clinical Decision Making: Acute Coronary Syndrome, Stable Ischemic Heart Disease, Interventional Cardiology, Vascular Medicine Abstract Category: Acute Coronary Syndromes Presentation Number: 1185-322 Authors: Sameer Chadha, Abhinav Saxena, Jignesh Patel, Jacob Shani, Bilal Malik, Maimonides Medical Center, Brooklyn, NY, USA
Background: There is paucity of data regarding optimal management of dual antiplatelet therapy (DAPT) in patients requiring urgent or emergent surgery. We present a challenging case where in urgent orthopedic surgery was required within four weeks of a complex PCI with drug eluting stents (DES).
Case: Sixty one year old female with history of triple vessel coronary artery disease and high risk for coronary artery bypass surgery underwent multi-vessel complex percutaneous coronary intervention (PCI) in 2013. She recently presented with non ST elevation myocardial infarction needing repeat PCI with DES to the Left Anterior Descending (LAD) and Obtuse Marginal second branch (OM2). She was discharged on aspirin and clopidogrel. Due to a mechanical fall, patient developed femur fracture within one week of PCI. She was initially managed conservatively for two weeks but owing to the nature of the fracture a decision to operate was taken and cardiology was consulted for management of dual antiplatelet therapy in the perioperative period. Decision Making: Current American College of Cardiology (ACC) and American Heart Association (AHA) guidelines recommend avoidance of surgery within twelve months of DES placement. Interruption of DAPT is associated with high risk of in-stent thrombosis. Our patient required urgent surgery within weeks of complex PCI. DAPT was continued in the perioperative period and intraoperative platelet transfusion was used to control excessive bleeding. This patient received a total of one unit of platelets. Patient recovered well from the surgery without thrombotic stent complications. This strategy was used for two more patients over the past five years with good outcomes without any stent thrombosis. Conclusions: This case demonstrates that in patients with recent DES, discontinuation of antiplatelet agents may not be required in the perioperative period. Continuation of dual antiplatelet therapy and utilization of intra-operative platelet transfusion if required to control excess bleeding appears to be a promising approach and warrants further investigation.