A patient posted for Lap Cholecystectomy had drug eluting stent placed two years back. Patient has no symptom since then. Which of the following set of investigation should be done in this patient.
Now, the next step is to consider the implications for surgery. The main concern here is anticoagulation management. Patients with stents are usually on dual antiplatelet therapy (DAPT) like aspirin and clopidogrel to prevent stent thrombosis. However, surgery poses a risk of bleeding. The guidelines for when it's safe to stop DAPT depend on the type of stent and the time elapsed since placement.
Bare metal stents usually require 4-6 weeks of DAPT, while drug-eluting stents (DES) require longer, typically 6-12 months or more. Since the patient had a drug-eluting stent two years ago, it's likely that they have completed the recommended DAPT duration. However, the exact duration can vary based on the type of DES and the patient's risk factors.
The question is about investigations. So, the key investigations would be those that assess the patient's current anticoagulation status. The most relevant test here is the platelet function test, such as VerifyNow or PFA-100, to check if the antiplatelet therapy is still active. Additionally, checking INR (International Normalized Ratio) if the patient is on warfarin, but since the question mentions a drug-eluting stent, the primary concern is antiplatelet agents, not anticoagulants like warfarin.
Wait, the options aren't provided, so I need to think about common investigations in such scenarios. Other possible investigations might include a complete blood count (CBC) to check for anemia or thrombocytopenia, and coagulation profile (PT/INR, aPTT). However, the key here is the platelet function testing because the patient might still be on antiplatelet drugs, which are critical to assess for surgical safety.
The other options might include irrelevant tests. For example, liver function tests might be relevant for a cholecystectomy, but the primary issue here is the stent and anticoagulation. So, the correct set of investigations would focus on coagulation status, particularly platelet function and current antiplatelet therapy status.
So, the correct answer would involve platelet function tests and possibly a review of current medications. The other options might include tests that don't address the stent's impact, like ECG or chest X-ray, which are not directly related to the stent's management for surgery.
**Core Concept**
This question examines the preoperative evaluation of a patient with a drug-eluting coronary stent undergoing surgery. Key considerations include assessing the duration of antiplatelet therapy and current bleeding risk.
**Why the Correct Answer is Right**
A drug-eluting stent (DES) requires dual antiplatelet therapy (DAPT) for 6–12 months to prevent stent thrombosis. Since this patient had the stent placed **2 years ago