Managing Coronary Artery Disease in the Cancer Patient

The cancer patient with coronary disease presents particular challenges that directly impact on the management of coronary disease, both stable and acute The frequent need for surgery in the cancer patient is an important consideration in avoiding a coronary artery stem or any percutaneous coronary intervention for management of chronic stable angina, which will delay surgery or pose of risk of stein thrombosis during surgery Cancer surgery is considered low or intermediate cardiac risk so revascularization before surgery is needed only in exceptional circumstances Medical treatment in most patients or coronary artery bypass graft in high risk situations may be preferable if the cancer is being actively treated The likelihood of thrombocytopenia, either pi unary from bone marrow disease, or secondarily during chemotherapy causes concern about the need for continuous use of platelet suppressing agents. aspirin for all patients, or double antiplatelet therapy in all patients tiller receiving a coronary artery stern Drug-eluting stents pose special problems and should be avoided Even bare metal stents may have a higher long-term risk of stem thrombosis in the cancer patient The increase in propensity for venous clotting, either as a result of the cancer itself, or especially with selected chemotherapeutic agents may be an issue after stenting and certainly early after coronary bypass surgery Aggressive medical treatment to reduce risk factors, especially with suit ins is essential to stabilize the underlying coronary disease (Prog Cardiovasc Dis 2010,53 149-156) (C) 2010 Elsevier Inc All rights reserved