{"id":"09697c6f-36dd-418f-9027-1deeb2097ac3","slug":"perioperative-dual-antiplatelet-therapy-for-patients-undergoing-spine-surgery-soon-after-drug-eluting-stent-placement","title":"Perioperative dual antiplatelet therapy for patients undergoing spine surgery soon after drug eluting stent placement","authors":["Sophie M. Peeters","Daniel Nagasawa","Bilwaj Gaonkar","Tianyi Niu","Alexander Tucker","Mark Attiah","Diana Babayan","Natalie Moreland","Isaac Yang","Marcela Calfon Press","Luke Macyszyn"],"abstract":"Background: Performing emergent spinal surgery within 6 months of percutaneous placement of drug-eluting coronary stent (DES) is complex. The risks of spinal bleeding in a “closed space” must be compared with the risks of stent thrombosis or major cardiac event from dual antiplatelet therapy (DAPT) interruption. Methods: Eighty relevant English language papers published in PubMed were reviewed in detail. Results: Variables considered regarding surgery in patients on DAPT for DES included: (1) surgical indications, (2) percutaneous cardiac intervention (PCI) type (balloon angioplasty vs. stenting), (3) stent type (drug-eluting vs. balloon mechanical stent), and (4) PCI to noncardiac surgery interval. The highest complication rate was observed within 6 weeks of stent placement, this corresponds to the endothelialization phase. Few studies document how to manage patients with critical spinal disease warranting operative intervention within 6 months of their PCI for DES placement. Conclusion: The treatment of patients requiring urgent or emergent spinal surgery within 6 months of undergoing a PCI for DES placement is challenging. As early interruption of DAPT may have catastrophic consequences, we hereby proposed a novel protocol involving stopping clopidogrel 5 days before and aspirin 3 days before spinal surgery, and bridging the interval with a reversible P2Y12 inhibitor until surgery. Moreover, postoperatively, aspirin could be started on postoperative day 1 and clopidogrel on day 2. Nevertheless, this treatment strategy may not be appropriate for all patients, and multidisciplinary approval of perioperative antiplatelet therapy management protocols is essential.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/09697c6f-36dd-418f-9027-1deeb2097ac3/featured/hero-1781562279410.png","publishDate":"2021-06-28T00:00:00.000Z","doi":"10.25259/SNI_337_2021","categories":["Spine","Review Article"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2021/06/10934/SNI-12-302.pdf"}