The American College of Cardiology and a multidisciplinary French Task Force have recently published guidance on perioperative stent thrombosis.1 2 We summarise these guidelines and highlight several simple steps that can be taken to minimise the risk of this potentially life threatening perioperative condition.

The introduction of coronary stents revolutionised percutaneous intervention in patients with coronary heart disease. Apart from preventing abrupt vessel closure, coronary stents reduce vessel recoil and restenosis.3 In 2006, coronary stents were deployed in more than 90% of the 70 000 percutaneous coronary interventions performed in the United Kingdom, with similar patterns of use reported worldwide.3 This has led to the emergence of two important complications—in-stent restenosis and stent thrombosis. Drug eluting stents, consisting of a stent covered by a thin polymer impregnated with antiproliferative drugs, have reduced the rates of in-stent restenosis by more than 70%, and nearly six million patients worldwide have received a drug eluting stent. …