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CHIRURGIA MAGGIORE

LINEE GUIDA E FLOW CHART OPERATIVA PER LA SOSPENSIONE “SICURA” DELLA TERAPIA ANTIAGGREGANTE IN PREPARAZIONE DELL’INTERVENTO. CHIRURGIA MAGGIORE. Risk of early surgery after stent implantation. Early surgery after stent implantation: High risk after discontinuation of dual antiplatelet therapy.

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CHIRURGIA MAGGIORE

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  1. LINEE GUIDA E FLOW CHART OPERATIVA PER LA SOSPENSIONE “SICURA” DELLA TERAPIA ANTIAGGREGANTE IN PREPARAZIONE DELL’INTERVENTO CHIRURGIA MAGGIORE

  2. Risk of early surgery after stent implantation

  3. Early surgery after stent implantation: High risk after discontinuation of dual antiplatelet therapy

  4. LINEE GUIDA ESC 2009

  5. VALUTAZIONE RISCHIO/BENEFICIO ED IMPATTO CLINICO trombosi emorragia DES su TC/IVA Ultimo vaso Neurochirurgia Chirurgia Oftalmica

  6. Risk factors for stent thrombosis

  7. STRATIFICAZIONE PER RISCHI TROMBOSI/EMORRAGIA RISCHIO EMORRAGICO RISCHIO TROMBOTICO Adattata da Riddell et al, Circulation 2007; 116: e378-e382

  8. Protocollo Ospedale Niguarda

  9. Clopidogrel bridging protocol Inclusion criteria • Consecutive candidates for urgent major (CV or non-CV) surgery • or eye surgery in whom dual antiplatelet therapy could not be withdrawn as the time of surgery was within 6 months of the placement of any DES, or within one year of the placement of any DES under conditions considered to be at higher risk for stent thrombosis: • stent implantation due to an ACS, • diabetes, • renal insufficiency or • severe left ventricular dysfunction, • stents placed in LMCA, proximal LAD (or equivalent), bifurcation

  10. - 8 cardiac surgery, 6 urinary tract , 10 gastroenteric surgery, 5 other surgery- No MACE ( death, MI, stroke )- 1 TIMI major bleeding- 8 patients required blood transfusion (6 before surgery for anemia, 2 post-operatively for proctorrhagy ). Global experience : 30 patients

  11. Patient characteristics and bleedinggastroenteric surgery

  12. Patient characteristics and bleedingurinary tract surgery

  13. Patient characteristics and bleeding: Cardiac surgery

  14. LIMITAZIONI DEL PROTOCOLLO ‘NIGUARDA’ • Utilizzo ‘off label’ del tirofiban • Persiste rischio emorragico non trascurabile • Incertezze associazione eparina

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