Roberta Rossini, Giuseppe Tarantini, Giuseppe Musumeci, Giulia Masiero, Emanuele Barbato, Paolo Calabrò, Davide Capodanno, Sergio Leonardi, Maddalena Lettino, Ugo Limbruno, Alberto Menozzi, U.O. Alfredo Marchese, Francesco Saia, Marco Valgimigli, Walter Ageno, Anna Falanga, Antonio Corcione, Alessandro Locatelli, Marco Montorsi, Diego Piazza, Andrea Stella, Antonio Bozzani, Alessandro Parolari, Roberto Carone, Dominick J. Angiolillo, Italian Society of Interventional Cardiology, Italian Society for the Study of Haemostasis and Thrombosis, Italian Society of Anesthesia and Intensive Care Medicine, Italian Society of Surgery, Italian Society for Cardiac Surgery, Italian Society of Vascular and Endovascular Surgery, Italian Society of Urology, Italian Orthopaedic Society, Italian Society of Thoracic Surgeons, Italian Federation of Scientific Societies of Digestive System Diseases, Italian Society of Digestive Endoscopy, Italian Association of Hospital Gastroenterology and Digestive Endoscopy, Italian Association of Gastroenterology and Digestive Endoscopy, Italian Society of Maxillofacial Surgery, Italian Society of Reconstructive Plastic Surgery and Aesthetics, Italian Society of Gynecology and Obstetrics, Italian Society of Neurosurgery, Italian Association of Hospital Pulmonologist, Italian Society of Periodontology, Italian Society of Ophthalmology, Italian Association of Hospital Otorhinolaryngologist, Italian Association of Hospital Surgeons, Association of Obstetricians Gynecologists Italian Hospital

Perioperative management of antithrombotic therapy in patients treated with coronary stents undergoing surgery remains poorly defined. Importantly, surgery represents a common reason for premature treatment discontinuation, which is associated with an increased risk in mortality and major adverse cardiac events. However, maintaining antithrombotic therapy to minimize the incidence of perioperative ischemic complications may increase the risk of bleeding complications. Although guidelines provide some recommendations with respect to the perioperative management of antithrombotic therapy, these have been largely developed according to the thrombotic risk of the patient and a definition of the hemorrhagic risk specific to each surgical procedure, key to defining the trade-off between ischemia and bleeding, is not provided. These observations underscore the need for a multidisciplinary collaboration among cardiologists, anesthesiologists, hematologists and surgeons to reach this goal. The present document is an update on practical recommendations for standardizing management of antithrombotic therapy management in patients treated with coronary stents (Surgery After Stenting 2) in various types of surgery according to the predicted individual risk of thrombotic complications against the anticipated risk of surgical bleeding complications. Cardiologists defined the thrombotic risk using a "combined ischemic risk" approach, while surgeons classified surgeries according to their inherent hemorrhagic risk. Finally, a multidisciplinary agreement on the most appropriate antithrombotic treatment regimen in the perioperative phase was reached for each surgical procedure.