Work

Successful Cancer Surgery Without Transfusion Following Early Discontinuation of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention for Acute Myocardial Infarction

Year: 2025

Type: article

Abstract: A 75-year-old Jehovah's Witness with recent ST-elevation myocardial infarction (STEMI) underwent percutaneous coronary intervention (PCI) with stenting of the proximal LAD. She was later diagnosed with gallbladder cancer and required urgent surgery but firmly refused allogeneic blood transfusion. This posed a major challenge, as the surgery was expected to cause significant bleeding, and the patient had undergone coronary stenting within the previous three months, which is when the risk of stent thrombosis is highest if dual antiplatelet therapy (DAPT) is interrupted. After conducting a careful multidisciplinary discussion and obtaining informed consent, both aspirin and clopidogrel were discontinued five days preoperatively. Through comprehensive blood conservation strategies-including acute normovolemic hemodilution (ANH), intraoperative cell salvage, and robotic-assisted minimally invasive surgery-the patient successfully underwent extended cholecystectomy without transfusion. This case highlights the possibility of safe, completely transfusion-free major surgery in patients with recent PCI and high thrombotic risk when individualized perioperative planning is applied.

Source: Journal of Clinical Medicine

DOI: 10.3390/jcm14186456

Authors: Sungmin Suh, Nayoung Kim, Sangho Kim

Institutions: Soonchunhyang University, Soonchunhyang University Hospital Seoul

Language: English

Topic: Blood transfusion and management

Subfield: Biochemistry

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,137