Recommendations for Perioperative Management–Timing of Elective Noncardiac Surgery in Patients Treated With PCI and DAPT

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2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease[1]

Recommendations for Perioperative Management–Timing of Elective Noncardiac Surgery in Patients Treated With PCI and DAPT

Class I
"1.Elective noncardiac surgery should be delayed 30 days after BMS implantation and optimally 6 months after DES

implantation(Level of Evidence: B-NR)"

"2.In patients treated with DAPT after coronary stent implantation who must undergo surgical procedures that

mandate the discontinuation of P2Y12 inhibitor therapy, it is recommended that aspirin be continued if possible and the P2Y12 platelet receptor inhibitor be restarted as soon as possible after surgery(Level of Evidence: C-EO)"

Class IIa
"1.When noncardiac surgery is required in patients currently taking a P2Y12 inhibitor, a consensus decision among treating

clinicians as to the relative risks of surgery and discontinuation or continuation of antiplatelet therapy can be useful.(Level of Evidence: C-EO)"

Class IIb
"1.Elective noncardiac surgery after DES implantation in patients for whom P2Y12 inhibitor therapy will need to be

discontinued may be considered after 3 months if the risk of further delay of surgery is greater than the expected risks of stent thrombosis(Level of Evidence: C-EO)"

Class III (No Benefit)
"1.Elective noncardiac surgery should not be performed within 30 days after BMS implantation or within 3 months

after DES implantation in patients in whom DAPT will need to be discontinued perioperatively(Level of Evidence: B-NR) "

  1. Levine GN, Bates ER, Bittl JA, Brindis RG, Fihn SD, Fleisher LA; et al. (2016). "2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.". J Thorac Cardiovasc Surg. 152 (5): 1243–1275. PMID 27751237. doi:10.1016/j.jtcvs.2016.07.044. 

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