Management of Antiplatelet Therapy Prior to Cardiac Catheterization

Aspirin Management

The American College of Cardiology recommends continuing aspirin through cardiac catheterization, as aspirin should not be discontinued and should be given indefinitely to all patients with acute coronary syndromes unless there is a true aspirin allergy 3, 4
Aspirin is a cornerstone of ACS management and should be maintained regardless of the reperfusion strategy employed 5

For unstable patients or known ACS, the American Heart Association recommends administering clopidogrel immediately, as the ischemic benefit outweighs bleeding risk in this population 2
For stable patients with planned catheterization within 24-36 hours, clopidogrel should be withheld until coronary anatomy is defined if urgent CABG cannot be excluded based on clinical presentation 1, 5
For patients with deferred catheterization (>24-36 hours), clopidogrel should be started immediately, as the waiting period justifies early antiplatelet therapy to prevent ischemic events 1

The American Heart Association recommends discontinuing clopidogrel for 5 days minimum, preferably 7 days, before elective CABG, as clopidogrel is an irreversible inhibitor of platelet function, requiring this washout period for adequate platelet recovery 1, 2, 4
However, experienced surgeons may proceed with "early" CABG (within 5 days of clopidogrel) at acceptable incremental bleeding risk in urgent situations 2
Early CABG after clopidogrel was associated with increased blood transfusion requirements but no difference in mortality, reinfarction, or stroke rates, according to the CRUSADE Registry 2

For patients already on clopidogrel for a recent stent, cardiology consultation is essential before any clopidogrel interruption, especially for drug-eluting stents placed within the prior year 6