Major thoracic surgery in patients under antiplatelet therapy

Advances in anticoagulant and antiplatelet regimes are associated with a significant risk reduction in the occurrence of thrombotic events. However, this thrombotic protection may carry an increased risk of bleeding during and after surgery. Aspirin is the main antiplatelet medication used in patients with coronary artery disease, nevertheless there is a growing evidence demonstrating that the use of the most potent antiplatelet medication, clopidogrel, on its own or in combination with aspirin, is more effective in both chronic and acute settings (1). The most recent recommendation for patients who have undergone to drug—eluting coronary artery stent placement advises toreceive the dual antiplatelet therapy for at least 12 months. Dual antiplatelet therapy has become the mainstay treatment strategy for the prevention of stent thrombosis. Premature discontinuation of antiplatelet therapy markedly increases the risk of stent thrombosis, a catastrophic event that frequently leads to myocardial infarction and/or death (2).