Resources

1. CCS Antiplatelet Guidelines  as of 2021 Interrupting DAPT for non cardiac surgery (ccs.ca)

Timing of Surgery

PCI with BMS

Recommendation: In patients undergoing PCI who are treated with a bare metal stent who require elective non-cardiac surgery, we recommend delaying surgery for at least 1 month after PCI (Strong Recommendation, Moderate Quality Evidence).

PCI with DES

Recommendation: In patients undergoing PCI who are treated with a drug eluting stent who require elective non-cardiac surgery, we recommend delaying surgery for at least 3 months after PCI (Strong Recommendation, Moderate Quality Evidence). If there is a need for semi-urgent non-cardiac surgery, we suggest delaying surgery for at least 1 month after PCI (Weak Recommendation, Low Quality Evidence).

Peri-Operative DAPT Management

Recommendation: In patients undergoing PCI who are treated with either a bare metal or drug eluting stent who require elective non-cardiac surgery, we suggest continuing ASA perioperatively whenever possible (Weak Recommendation, Low Quality Evidence).

Recommendation: In patients undergoing PCI who are treated with a bare metal or drug eluting stent who require elective non-cardiac surgery, we suggest withholding clopidogrel and ticagrelor for 5-7 days pre-operatively, and prasugrel for 7-10 days pre-operatively (Weak Recommendation, Low Quality Evidence).

Recommendation: In patients undergoing PCI who are treated with a bare metal or drug eluting stent and who have undergone non-cardiac surgery, we suggest restarting maintenance dose DAPT after surgery, as soon as it is deemed safe by the surgeon (Weak Recommendation, Very Low Quality Evidence).