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Perioperative Antiplatelet Management — EECC MCQ

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ModerateCoronary Artery DiseasePerioperative Antiplatelet ManagementEECC

A 70-year-old man with a history of NSTEMI treated with PCI 6 months ago is scheduled for an elective total hip replacement. He is on aspirin 75 mg and ticagrelor 90 mg twice daily. What is the recommended antiplatelet management perioperatively?

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Correct answer: A — Stop ticagrelor 5 days before surgery; continue aspirin throughout

For elective non-cardiac surgery after PCI with DES, the minimum recommended period before elective surgery is 6 months after ACS (3 months if low bleeding risk). Since 6 months have elapsed, surgery can proceed. Ticagrelor should be stopped at least 3-5 days before surgery (ESC recommends 5 days based on platelet recovery time). Aspirin should be continued throughout the perioperative period unless the bleeding risk is exceptionally high (e.g. intracranial surgery). Bridging with cangrelor is not standard practice for elective non-cardiac surgery.

Reference: ESC (2023): Guidelines for the Management of Acute Coronary Syndromes; ESC (2022): Guidelines on Non-cardiac Surgery