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7/18/2003

Heart Revascularization Procedure Requires Attention to Pharmacotherapy

Cheryl A. Thompson

Patients who undergo percutaneous coronary revascularization to restore the blood supply to an area of the heart benefit from their care team understanding how to manage the risks and complications of the procedure. With that principle in mind, a committee of the American Heart Association Council on Clinical Cardiology this week issued a document (PDF) reviewing the possible complications of percutaneous coronary revascularization and recommending preventive measures.

In brief, the committee recommended:

  • Prednisone 60 mg the night before and morning of the procedure and oral diphenhydramine 50 mg or an equivalent dose of another histamine H1-receptor blocker the morning of the procedure if the patient had an anaphylaxis-like reaction to a contrast agent during a previous examination,   
  • Hydration therapy with 0.45 percent sodium chloride injection at 1 mL/hour per kilogram of body weight for 12 hours before and after the procedure if the patient has renal insufficiency,   
  • No doses of the hypoglycemic agent metformin on the day of the procedure if the patient has normal renal function, and no doses for 48 hours if the patient has renal insufficiency and is at increased risk for contrast agent-induced nephropathy,   
  • Aspirin 80–325 mg at least two hours beforehand,   
  • No pretreatment with clopidogrel if the patient has not undergone diagnostic cardiac catheterization and may be a candidate for coronary artery bypass grafting within seven days of the revascularization procedure,   
  • Clopidogrel therapy for four weeks and aspirin therapy if the patient receives a bare coronary artery stent, and   
  • Clopidogrel therapy for at least three months and aspirin therapy if the patient receives a drug-eluting stent.

The committee recommended that clinicians seriously consider extending clopidogrel therapy for at least one year after the procedure if the patient has diabetes mellitus, chronic renal failure, diffuse or multiple-vessel coronary artery disease, atherosclerotic disease in other vessels, or an acute coronary syndrome.

The document, "Management of Patients Undergoing Percutaneous Coronary Revascularization," was published in the July 15 issue of Annals of Internal Medicine.