Thrombozytenaggregationshemmung Während der Perioperativen Periode

Antiplatelet therapy in form of acetyl salicylic acid (ASA) and/or thienopyridines constitutes a cornerstone in preventing thrombotic complications of coronary artery disease, including stent thrombosis after percutaneous coronary intervention. Premature interruption of dual antiplatelet therapy is one of the most important risk factors for stent thrombosis, a condition which may often be fatal. Current guidelines recommend dual therapy for at least one year after drug-eluting stents. Antiplatelet therapy is frequently stopped before invasive procedures or noncardiac surgeries because of an increased risk of bleeding complications, which may however lead to life-threatening thrombotic complications. We suggest an algorithm to assist clinicians to choose the suitable regimen for each patient after weighing the risk of stent thrombosis versus the risk of acquiring a bleeding complication. After stratifying the risk for thrombosis into «HIGH» or «NORMAL» according to given criteria, the bleeding risk is then stratified into «HIGH» or «NORMAL». Accordingly, four scenarios for the perioperative antiplatelet therapy exist: dual antiplatelet therapy should be continued perioperatively, ASA should be administered together with short-acting glycoprotein (GP) IIb/IIIa antagonists, ASA only should be continued or both drugs may be stopped.