A 63-Year-Old Man Is Scheduled for Coronary Artery Bypass Surgery

question 65

Multiple Choice

A 63-year-old man is scheduled for coronary artery bypass surgery.  He underwent cardiac catheterization for a 2-month history of effort-limiting angina and was found to have left main coronary artery stenosis.  One year ago, the patient underwent drug-eluting stent placement in the right coronary artery.  The patient's other medical problems include type 2 diabetes mellitus and obesity.  His current medications are low-dose aspirin, clopidogrel, rosuvastatin, metoprolol, and basal-bolus insulin therapy.
Vital signs are within normal limits except for BMI of 35 kg/m².  Cardiopulmonary examination is unremarkable.
ECG shows sinus rhythm with normal intervals, minimal voltage criteria for left ventricular hypertrophy, and no pathologic Q waves.  The patient's most recent echocardiogram showed a left ventricular ejection fraction of 50% with no regional wall motion or valvular abnormalities.
Which of the following is the most appropriate management of this patient's antiplatelet medication before surgery?

• A)Continue both antiplatelet agents
• B)Start enoxaparin and discontinue aspirin and clopidogrel the day before surgery
• C)Stop aspirin and clopidogrel 5 days before surgery
• D)Stop only aspirin 5 days before surgery
• E)Stop only clopidogrel 5 days before surgery

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Understand and apply the journalistic approach to include all required information.

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