8
Treatment
Table 4. Perioperative Therapy (cont'd)
Recommendations COR LOE
Antiplatelet agents
Continue DAPT in patients undergoing urgent noncardiac
surgery during the first 4-6 weeks aer BMS or DES
implantation, unless the risk of bleeding outweighs
the benefit of stent thrombosis prevention. In patients
undergoing urgent noncardiac surgery during the first 4-6
weeks aer BMS or DES implantation, dual antiplatelet
therapy should be continued unless the relative risk of
bleeding outweighs the benefit of the prevention of stent
thrombosis.
I C
In patients who have received coronary stents and
must undergo surgical procedures that mandate the
discontinuation of P2Y
12
platelet receptor–inhibitor
therapy, it is recommended that aspirin be continued if
possible and the P2Y
12
platelet receptor–inhibitor be
restarted as soon as possible aer surgery.
I C
Management of the perioperative antiplatelet therapy
should be determined by a consensus of the surgeon,
anesthesiologist, cardiologist, and patient, who should
weigh the relative risk of bleeding with that of stent
thrombosis.
I C
In patients undergoing nonemergency/nonurgent
noncardiac surgery without prior coronary stenting
who have not had previous coronary stenting, it may be
reasonable to continue aspirin when the risk of increased
cardiac events outweighs the risk of increased bleeding.
IIb B
Initiation or continuation of aspirin is NOT beneficial in
patients undergoing elective noncardiac noncarotid surgery
who have not had previous coronary stenting.
III: No
Benefit
B
C: If risk
of ischemic
events
outweighs
risk of
surgical
bleeding
