Minimal withdrawal of dual antiplatelet agents under the guidance of a point-of-care platelet activity assay early after drug-eluting stent implantation for surgical removal of renal cell carcinoma.

A 58-year-old man presented with unstable angina, for whom drug-eluting stent (DES) was successfully implanted in mid portion of left anterior descending artery and diagonal branch bifurcation. During hospitalization, renal cell carcinoma was incidentally found. Right radical nephrectomy was planned 5 weeks after the DES insertion to minimize thrombotic risk following discontinuation of antiplatelet agents. Seven days and 5 days prior to the operation, clopidogrel and aspirin were withdrawn respectively while platelet activity was serially monitored using VerifyNow Aspirin/P2Y12 assay. According to the results of the assay, the infusion of tirofiban was started from the third day after stopping dual antiplatelet therapy and maintained till 8 h prior to the nephrectomy. With the help of this bridge therapy, the surgery was successfully performed and histology confirmed a renal cell carcinoma. Clopidogrel and aspirin were resumed the next day after the operation. Eight days after his nephrectomy, the patient was discharged without stent thrombosis or bleeding complication.