Algorithm for preoperative management of patients taking antiplatelet therapy. ACS, acute coronary syndrome; BMS, bare metal stent; DES, drug-eluting stent;

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Algorithm for preoperative management of patients taking antiplatelet therapy. ACS, acute coronary syndrome; BMS, bare metal stent; DES, drug-eluting stent; MI, myocardial infarction; PAD, peripheral arterial disease; PCI, percutaneous coronary intervention. *High-risk stents: long (>36 mm), proximal, overlapping, or multiple stents, stents in chronic total occlusions, or in small vessels or bifurcated lesions. **Examples of low-risk situations: more than 3 months after BMS, stroke, uncomplicated MI, PCI without stenting. ***Risk of bleeding in closed space: intracranial neurosurgery, intramedullary canal surgery, posterior eye chamber ophthalmic surgery. In these situations, the risk-to-benefit ratio of upholding versus withdrawing aspirin must be evaluated for each case individually; in case of aspirin upholding, early postoperative reinstitution is important. ****Modification to reflect updated recommendations from Levine GN, Bates ER, Bittl JA, et al. 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease. A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. 68(10):1082-1115. [Modified with permission from Chassot PG, Delabays A, Spahn DR: Perioperative antiplatelet therapy: the case for continuing therapy in patients at risk of myocardial infarction. Br J Anaesth. 2007 Sep;99(3):316-328.] Source: Overview of Preoperative Assessment and Management, Anesthesiology, 3e Citation: Longnecker DE, Mackey SC, Newman MF, Sandberg WS, Zapol WM. Anesthesiology, 3e; 2017 Available at: https://accessanesthesiology.mhmedical.com/DownloadImage.aspx?image=/data/books/2152/longnecker3_ch5_f003.png&sec=164216352&BookID=2152&ChapterSecID=164216270&imagename= Accessed: October 22, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved