The perioperative management of antiplatelet therapy for patients with coronary stents remains unclear. This review was requested to assess the evidence for the following key questions: among patients on APT in conjunction with percutaneous coronary intervention (PCI) undergoing elective surgical procedures, including intraocular procedures, what are the benefits and harms of holding APT prior to surgery? How does benefit/risk vary by the timing of discontinuation? How does benefit/risk vary by type of surgical procedure, including intraocular procedures? How does benefit/risk vary by type of APT? How does benefit/risk vary by the timing of resuming APT? We conducted searches in PubMed, Web of Science, and Scopus from inception of each database to 12/17/2015. Thirteen observational studies reported the details of preoperative APT, perioperative APT management, and outcomes, in sufficient detail to assess their association. In general, within studies the bleeding outcomes were reported at higher rates than the MACE outcomes, timing of cessation, bridging, restarting therapy, and type of APT. Additionally, the varied range of invasiveness of the procedure, from skin excisions to major thoracic cases, contributes to the operative bleeding risk and MACE risk, yet many studies lacks sufficient detail to assess the impact of procedure on the outcomes. The results also suggest that clinical factors other than perioperative APT management may be in part responsible for MACE and bleeding outcomes. It is likely that a clinical trial of large size would be needed to more definitely provide evidence about this clinical decision.

The perioperative management of antiplatelet therapy (APT) for patients with coronary, cerebrovascular, or peripheral vascular stents remains unclear. After percutaneous coronary intervention, American College of Cardiology (ACC) and American Heart Association (AHA) guidelines recommend delaying elective non-cardiac surgery, ideally 6 months following drug-eluting stent placement and 30 days after bare metal stent placement. For patients on dual antiplatelet therapy (DAPT), ACC/AHA guidelines recommend continuing at least aspirin (ASA) throughout the perioperative period and restarting the P2Y12 inhibitor as soon as possible following surgery. However, this latter recommendation is based on expert opinion and was the focus of a recent ESP report. The conclusion of this report was that studies evaluating APT therapy in patients with coronary stents had significant methodologic limitations and that APT therapy likely has a small impact on perioperative bleeding and major adverse cardiac event (MACE) outcomes, compared to other clinical factors such as operative urgency and timing since stent implantation.

This book focuses on the coronary bioresorbable scaffold, a new interventional treatment for coronary artery disease, differentiated from a permanent metallic stent. The book provides an overview of the technology including non-clinical studies and clinical evidences in order to help clinicians understand the appropriate application of the technology and the optimal techniques of implantation. It covers the basics of bioresorbable scaffolds; bench test results; preclinical studies; clinical evidences; and tips and tricks of implantation.

Clinical application of antithrombotic therapy in both arterial disease (acute coronary syndromes, acute MI, peripheral arterial disease, valvular heart disease, atrial fibrillation) and venous disease, (venous thromboembolic disease and pulmonary embolism). Results of major clinical trials and their implications for clinical practice.

Edited by a team of the world’s leading interventional cardiologists and educators, this new book is created with an eye to giving the reader a solid, practical, and clinically focused understanding of this important class of drugs, from basic science to a clear-headed discussion of complex topics such as combination therapies, drug-to-drug interactions, and resistance to antiplatelet agents. This important new book: Begins with a concise but thorough discussion of platelet biology and pathophysiology so that readers understand how antiplatelet agents work and why they produce such a varied range of complications, from minor GI upset to potentially life-threatening conditions such as neutropenia, a critical shortage of white blood cells. Thoroughly covers platelet function testing, including novel techniques. Clarifies current best practice regarding the use of antiplatelet agents in both chronic and acute cardiovascular disease. Reviews all types of antiplatelet agents – from aspirin to recently approved drugs – including indications, clinical outcomes, and side effects. Written by an international “who’s who” of experts in the field, Antiplatelet Therapy in Cardiovascular Disease also includes an entire section covering the use of antiplatelet drugs in PCIs, including percutaneous valve repair, which makes this text particularly essential to interventional cardiologists.

* Draws from expertise of leaders in antiplatelet therapy * Easy-to-use layout enables rapid browsing * Edited by a member of the prestigious TIMI study group withlong-standing experience in the field

This book will consider several clinical and interventional topics for which there is uncertainty, continued debate and/or no consensus based on current guidelines. While there are numerous guidelines in cardiology, new and on-going trials that address new drugs treatments and procedures raise many unanswered questions. Furthermore, most practicing cardiologist taking care of the patients are likely unable to digest all of these studies or guidelines and necessarily correctly apply them to their patients. If one considers in the guidelines the frequent use of Level C (consensus), there are many areas or situations where no trial exists. Also, when applying the results of a trial to an individual patient, there can be uncertainty of how this patient should be managed based on the present body of evidence.

Expert guidance from internationally recognized authorities, who provide clear and current updates on all aspects of interventional cardiology. This new edition; Contains a radically expanded chapter contents list presented in four clear sections; coronary interventions, interventional pharmacology, structural heart interventions, and endovascular therapy Includes 46 new chapters, including the latest advances in bioresorbable coronary stents, advanced transcatheter aortic valve replacement, MitraClip, new transcatheter mitral valve interventions, and more Chapters are templated for rapid referral, beginning with pathophysiological background and relevant pathology, moving to mechanisms of treatment, device description, procedural techniques, follow-up care, and ending with risks, contraindications and complications Multiple choice questions at the end of each chapter for self-assessment, a total of more than 400 MCQs in the book Features 19 procedural videos, hosted on a companion website