Ask the Doctors April 2009 Issue

Ask The Doctors: 04/09

Your question is very timely, since your situation occurs more and more frequently these days. Before a surgical date is made, it is crucial that the first thing you do is contact your cardiologist about the impending procedure. He or she should be able to provide specific instructions for perioperative care and medications, the most important of which are aspirin and clopidogrel (Plavix). Depending upon which type(s) of stents you received, and how long ago they were placed, the instructions will be different. If aspirin and clopidogrel are discontinued too soon, your risk of developing in-stent thrombosis (a clot inside the stent) and a heart attack are substantially elevated. For drug-eluting stents (DES), the current recommendations in the United States are to treat with uninterrupted aspirin and clopidogrel for a minimum of one year. At Cleveland Clinic, we prefer at least two years of such therapy. One option is to delay the surgery until the recommended time is complete. If surgery is urgent, patients with DES have two options: undergo the surgery on aspirin and clopidogrel (which increases the bleeding risk, and is often vetoed by the surgeon), or receive IV medication with a similar effect to clopidogrel as "bridging" therapy during the entire perioperative period.

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