"There is a high risk of discontinuation of therapy with anti-ischemic agents in the perioperative period, despite level I evidence for continuation, with significant cardiac morbidity from discontinuation," he added. "Physicians must carefully review perioperative medications and ensure they are appropriately managed in this critical perioperative period of high cardiac risk."
The first comment is that as the vulnerable interval of time is the first postoperative month it implies that it is a biological phenomenom which lasts one month. It is a very fast process in the first week and decreases in the fourth one.
Another comment about this period: the kind of procedure influences the postoperative course in terms of inflammation. And inflammation tends to increase the risk of plaque rupture in the coronary arteries or other main arteries. The lack of information about inflammatory markers in the study does not allow to answer this question. By the way we cannot prescribe non steroidal anti-inflammatory drugs because they can also increase the risk of MI. So the potential of other anti-inflammatory molecules like long PUFA of the omega 3 series could be an option but requires further studies.
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