A patient is on dual antiplatelet therapy (aspirin + clopidogrel) following coronary artery stenting 3 months ago and requires elective laparoscopic cholecystectomy. What is the correct management of antiplatelet therapy?
- A Stop both aspirin and clopidogrel 7 days before surgery
- B Continue both antiplatelet agents throughout the perioperative period
- C Replace both with warfarin bridging therapy
- D Stop clopidogrel 5–7 days preoperatively; continue aspirin; consult cardiology — delay surgery to ≥6 months post-stenting if possible ✓
Explanation
After coronary stent placement, stopping dual antiplatelet therapy (DAPT) prematurely risks catastrophic stent thrombosis. Current guidelines (ACC/AHA, ESC) recommend: for bare-metal stents, DAPT for minimum 1 month; for drug-eluting stents (DES), minimum 6 months before elective surgery. If surgery cannot be deferred, clopidogrel is withheld 5–7 days before surgery while aspirin is continued (aspirin alone provides partial protection). The anaesthetist must consult cardiology and the cardiologist who placed the stent. Bridging with warfarin or heparin does not protect against platelet-mediated stent thrombosis.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
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