What is the recommended preoperative management for a patient who has received a drug-eluting stent (DES) and is scheduled for coronary artery bypass grafting (CABG)?

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In the context of preoperative management for a patient with a drug-eluting stent (DES) scheduled for coronary artery bypass grafting (CABG), the correct approach involves balancing the risk of thrombosis from premature discontinuation of antiplatelet therapy and the risk of bleeding associated with surgery.

The administration of dual antiplatelet therapy (DAPT), typically consisting of aspirin and a P2Y12 inhibitor like clopidogrel, is crucial for patients with DES to prevent stent thrombosis. However, when a surgical procedure such as CABG is necessary, the timing of surgery relative to the patient's antiplatelet therapy becomes essential.

Discontinuing clopidogrel 5 days prior to CABG while continuing aspirin is a recommended strategy to minimize bleeding risk during surgery. This preoperative discontinuation allows for adequate recovery time from the antiplatelet effects of clopidogrel, reducing the risk of surgical complications without significantly increasing the risk of stent thrombosis, especially if the procedure is performed within an appropriate timeframe post-stenting (usually within 6-12 months).

Continuing aspirin is critical, as it maintains some level of antiplatelet protection against thrombotic events. The decision to proceed with

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