Cardiology>>>>>Assessment for Surgery
Question 7#

A 75-year-old woman is admitted with an episode of unstable angina. She develops anterior T-wave inversion on her ECG and serum troponin is elevated. Initial treatment includes aspirin and clopidogrel. She undergoes coronary angiography which demonstrates a culprit lesion in the mid-course of the LAD. This is treated with a drug-eluting stent with good results. LV function is preserved.

Forty-eight hours post-procedure she has an episode of frank haematuria and then develops clot retention. The urology registrar reviews her and recommends stopping her antiplatelets.

What is your response?

A. Stop aspirin but continue clopidogrel—the benefits of aspirin are unproven
B. Stop aspirin and clopidogrel—the risks from bleeding outweigh risks of a further coronary event
C. Stop clopidogrel and continue aspirin—the half-life of clopidogrel is longer
D. Stop neither—the risks of stent thrombosis outweigh the risks of bleeding
E. Stop anti-platelets and replace with an IV heparin infusion since the effects are more predictable

Correct Answer is D

Comment:

The risks of acute stent thrombosis are high unless full antiplatelet therapy is given. Neither agent alone is suitable. Heparin is not a substitute.