A patient taking dual antiplatelet therapy (aspirin + clopidogrel) for a drug-eluting coronary stent placed 8 months ago requires urgent hip arthroplasty. The most appropriate anaesthetic management regarding antiplatelet therapy is:

• A Stop both antiplatelet agents 7–10 days before surgery; proceed with general anaesthesia
• B Stop both agents and start heparin bridging therapy
• C Continue both agents through surgery as drug-eluting stent thrombosis risk exceeds surgical bleeding risk
• D Continue aspirin; stop clopidogrel for 5–7 days before surgery; general anaesthesia preferred over neuraxial ✓

Explanation

Drug-eluting stents require dual antiplatelet therapy for at least 12 months to prevent life-threatening stent thrombosis. After 6 months, clopidogrel may be stopped 5–7 days preoperatively if surgery cannot be delayed further, but aspirin should be continued perioperatively as stopping it increases the risk of stent thrombosis. For neuraxial anaesthesia, current ASRA guidelines require stopping clopidogrel for 7 days, making general anaesthesia the preferred technique when clopidogrel cannot be safely stopped. Heparin bridging does not cover ADP receptor-mediated platelet activation and is not standard for antiplatelet management.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.