The increasing number of individuals treated with drug-eluting stents can be problematic perioperatively, especially when antiplatelet therapy must be discontinued (eg, emergency spinal surgery). Such patients are at very increased risk of thrombosis and perioperative MI. Anesthesia providers should never for nonsurgical reasons (eg, desire to perform a spinal anesthetic) discontinue antiplatelet or antithrombotic agents perioperatively without first discussing the risks and benefits of the proposed anesthetic requiring suspension of antiplatelet therapy with the patient and his or her cardiologist. The ACC/AHA guidelines offer recommendations on the approach of bringing patients to surgery following percutaneous coronary interventions and the type of interventions suggested when subsequent surgery is expected (Figure 21-3). Patient with coronary stent FIGURE 21-3 Algorithm for antiplatelet management in patients with percutaneous coronary intervention (PCI) and noncardiac surgery. Colors correspond to the following classes of recommendations: class I, green; class IIa, Scanned with CamScanner