Hate to bring up this topic again..
Reviewing a chart today I came across a 67 year old lady, that is about 90 days out from a DES after an NSTEMI, scheduled for upcoming CEA due to critical ICA stenosis >90% occlusion that was found out routine screening. Been asymptomatic neurologically. Cardiologist has "cleared" patient provided ASA/plavix is not interrupted and vascular is fine with that.
Copied from a previous post, from ACC/AHA
5.2. Timing of Elective Noncardiac Surgery in Patients With Previous PCI
- Elective noncardiac surgery should be delayed 14 days after balloon angioplasty.
- Elective noncardiac surgery should optimally be delayed 365 days after DES.
- Consensus decision among treating physicians about risks of surgery and antiplatelet therapy.
- Elective noncardiac surgery after DES can be considered after 180 days, if the risk of further delay is greater than the risk of ischemia and stent thrombosis.
- Elective noncardiac surgery should not be performed within 30 days after BMS, or 12 months after DES if dual antiplatelet therapy will need to be discontinued periop.
- Elective noncardiac surgery should not be performed within 14 days of balloon angioplasty if aspirin will need to be discontinued periop.
The ambiguity for me is if the ASA/Plavix is to be continued is it ok to proceed with surgery less than 180 days post DES. How do we know the risk of CVA in the next 90 days is greater than risk of MI in the next 90 days if we go ahead with surgery? Is it even my call to make? I would think as long as we document that patient explained that she has an increased risk of perioperative MI than if we waited another 90 days we'd be covered but I'm not sure.
Reviewing a chart today I came across a 67 year old lady, that is about 90 days out from a DES after an NSTEMI, scheduled for upcoming CEA due to critical ICA stenosis >90% occlusion that was found out routine screening. Been asymptomatic neurologically. Cardiologist has "cleared" patient provided ASA/plavix is not interrupted and vascular is fine with that.
Copied from a previous post, from ACC/AHA
5.2. Timing of Elective Noncardiac Surgery in Patients With Previous PCI
- Elective noncardiac surgery should be delayed 14 days after balloon angioplasty.
- Elective noncardiac surgery should optimally be delayed 365 days after DES.
- Consensus decision among treating physicians about risks of surgery and antiplatelet therapy.
- Elective noncardiac surgery after DES can be considered after 180 days, if the risk of further delay is greater than the risk of ischemia and stent thrombosis.
- Elective noncardiac surgery should not be performed within 30 days after BMS, or 12 months after DES if dual antiplatelet therapy will need to be discontinued periop.
- Elective noncardiac surgery should not be performed within 14 days of balloon angioplasty if aspirin will need to be discontinued periop.
The ambiguity for me is if the ASA/Plavix is to be continued is it ok to proceed with surgery less than 180 days post DES. How do we know the risk of CVA in the next 90 days is greater than risk of MI in the next 90 days if we go ahead with surgery? Is it even my call to make? I would think as long as we document that patient explained that she has an increased risk of perioperative MI than if we waited another 90 days we'd be covered but I'm not sure.