Gaspardone Achille. Protocolli di sospensione della Terapia Antiaggregante e Anticoagulante nei pazienti da sottoporre a chirurgia non cardiaca e a procedure endoscopiche. ASMaD 2012
•
1 like•1,335 views
Recommended
Recommended
More Related Content
What's hot
Similar to Gaspardone Achille. Protocolli di sospensione della Terapia Antiaggregante e Anticoagulante nei pazienti da sottoporre a chirurgia non cardiaca e a procedure endoscopiche. ASMaD 2012
Similar to Gaspardone Achille. Protocolli di sospensione della Terapia Antiaggregante e Anticoagulante nei pazienti da sottoporre a chirurgia non cardiaca e a procedure endoscopiche. ASMaD 2012 (20)
More from Gianfranco Tammaro
More from Gianfranco Tammaro (20)
Recently uploaded
Recently uploaded (20)
Gaspardone Achille. Protocolli di sospensione della Terapia Antiaggregante e Anticoagulante nei pazienti da sottoporre a chirurgia non cardiaca e a procedure endoscopiche. ASMaD 2012
- 2. Doctors Debate Safety of Coronary Stents for Patients Having Other Surgery March 2010
- 3. Prevalenza ~ 2.5 milioni di italiani
- 7. Joner, M. et al. J Am Coll Cardiol 2006;48:193-202
- 8. Risk of Surgery After Coronary Stenting N° of Surgery Study Stent type % Major Complications pts post-PCI Kaluza et al 32% ≤ 2 weeks 40 1-6 weeks BMS JACC 2000 0% > 2 weeks Wilson et al 4.8% ≤ 6 weeks Mayo Clinic 207 ≤ 2 months BMS 0% > 6 weeks JACC 2003 Sharma et al 1-12 weeks 26% ≤ 3 weeks Cath Cardiov Int 47 BMS Clopidogrel stopped 5% > 3 and <12 weeks 2004 Reddy et al 50% ≤ 6 weeks 56 < 6 weeks BMS Am J Cardiol 2005 0% > 6 weeks Compton et al 38 Median 260 days DES 0% (41% on DAT) Am J Cardiol 2006 Kim et al DAT stopped 5-7 239 days before elective BMS/DES 2.2% MACE DES/0% BMS Int J Cardiol 2006 surgery Vincenzi et al DAT stopped <72 103 hrs before elective BMS/DES 2.2% MACE DES/0% BMS Br J Anaesth 2006 surgery or continue Shouten et al 17% MACE early surgery 192 < 2 years BMS/DES JACC 2007 <35 days
- 9. Incidence of Non Fatal MI and Cardiac Death Within 30 Days After Non Cardiac Surgery in Patients with Early Surgery after PCI With or Without Antiplatelet Therapy % 40 30.7% 30 24% 20% 20 p=0.026 ns 10 0% 0 Discontinued (13) Continued (17) Blood Tr D Blood Tr C Shouten et al, JACC 2007
- 10. Sospensione della Terapia Antiaggregante 100 % 80 60 40 20 0 Indicazione Sospensione Altre cause medica autonoma dati GISE 2010
- 11. Angiolillo, D. J. et al. Eur Heart J 2010 31:17-28
- 13. Acute Stent Thrombosis • STEMI, Ventricular Fibrillation, Cardiogenic shock • Myocardial necrosis ~100% • Death ~50% • Only Rx: Reopening occluded vessel(s)
- 14. Strategies for Perioperative Management of Patients with Stent • Aspirin and thienopyridines throughout surgery (low surgical haemorrhagic risk) • Discontinue thienopyridines and mantain aspirin • “Bridging therapy” with (aspirin and) heparin • “Bridging therapy” with (aspirin and) GP IIA/IIIB Inhibitor • Novel Antiplatelets
- 15. DAT → Heparin Switching Stop DAT 3 days before surgery Start UFH or LMWH 4.9% mortality due to ST Vincenzi MN et al, Br J Anaesth 2006;96:686.93
- 32. Glycoprotein IIb/IIIa Inhibitor • Abciximab – Antibody – Irreversible antagonism – Inhibition of platelet aggregation 48h-7 days • Tirofiban, Eptifibatide – Synthetic peptides – Competitive reversible low affinity binders – Short half-life – Platelet function completely restored 2-4 h after stopping the infusion
- 33. “Bridge Therapy” con Inibitori GP IIb/IIIa • Stop Clopidogrel 5 giorni prima • 3 giorni prima dell’intervento stop Aspirina e inizio infusione di Tirofiban (0.1 mg/Kg/min) in associazione a UFH (1000 UI/h) con PTT/ACT ≥1.5 e ≤ 2.5 • Stop Tirofiban e UFH 6-8 ore prima dell’intervento • 1° giorno post-operatorio dose di carico di Clopidogrel (300 mg) e Aspirina 500 mg e.v. • 2° giorno post-operatorio dose di mantenimento di clopidogrel (75 mg) e aspirina (100 mg)