Drug-eluting Stent Thrombosis and Acute Myocardial Infarction in PACU

Abstract

Lately, more patients have been presenting for noncardiac surgery after recent placement of cardiac stents, either bare-metal stents or drug-eluting stents. Noncardiac surgery performed following recent stent placement poses risk of acute stent thrombosis due to inherent hypercoagulable state of surgery as well as the common practice of perioperatively discontinuing antiplatelet therapy, which may result in major adverse cardiac events such as stent thrombosis, myocardial infarction and death. Acute stent thrombosis accounts for up to a 60% acute myocardial infarction rate and up to a 45% mortality rate. The risk of perioperative bleeding associated with continued antiplatelet therapy must be weighed against the catastrophic event of stent thrombosis. We report a challenging case involving DES thrombosis and acute myocardial infarction in the immediate postoperative period. This case highlights the importance of the scientific advisory recently released by the American Heart Association and American College of Cardiology against the premature discontinuation of antiplatelet therapy in patients with coronary stents.