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Management Issues in Patients Requiring Antiplatelets and Anticoagulation

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Dr Suresh K, Trivandrum    05 January 2018

  1. Proper preoperative cardiac risk assessment using conventional risk scoring systems helps in planning appropriate management strategy.
  2. Dobutamine stress echo (DSE) indicates presence of CAD.
  3. Postsurgical probability of a cardiac event is low even if DSE is positive. If DSE shows high risk features indicative of multivessel/LMCA/proximal LAD disease or large areas of myocardium in jeopardy, consider invasive coronary evaluation and even urgent preop coronary revascularization.
  4. In general, there is no role for routine prophylactic coronary angiography (CAG) or revascularization in stable CAD awaiting noncardiac surgery. In subjects at risk of, or with proven IHD, aspirin nonadherence/withdrawal triples the risk of MACE.
  5. DVT prophylaxis following the hip surgery - 28-35 days of added anticoagulants - NOACs have an edge over heparin/VKA.

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