Bridge with intravenous antiplatelet therapy during temporary withdrawal of oral agents for surgical procedures: A systematic review

Nuccia Morici, Lorenzo Moja, Valentina Rosato, Alice Sacco, Antonio Mafrici, Silvio Klugmann, Maurizio D'Urbano, Carlo La Vecchia, Stefano De Servi, Stefano Savonitto

Research output: Contribution to journalArticle

Abstract

Patients needing surgery within 1 year after drug-eluting cardiac stent implantation are challenging to manage because of an increased thrombotic and bleeding risk. A "bridge therapy" with short-acting antiplatelet agents in the perioperative period is an option. We assessed the outcome and safety of such a bridge therapy in cardiovascular and non-cardiovascular surgery. We performed a comprehensive search of MEDLINE, EMBASE, the Cochrane Library, and ongoing trial registers, irrespective of type of design. Our primary outcome was the success rate of bridge therapy in terms of freedom from cardiac ischaemic adverse events, whereas secondary outcome was freedom from bleeding/transfusion. We also performed combined success rate for each bridge therapy drug (tirofiban, eptifibatide, and cangrelor). We included eight case series and one randomised controlled trial. Among the 420 patients included, the technique was effective 96.2 % of the times [95 % confidence interval (CI) 94.4-98.0 %]. The success rate was 100 % for tirofiban (4 studies), 93.8 % for eptifibatide (4 studies), and 96.2 % for cangrelor (1 study). Freedom from bleeding/transfusion events was observed in 72.6 % of the times (95 % CI 68.4-76.9 %), and was higher with cangrelor (88.7 %; 95 % CI 82.7-94.7 %) than with other drugs (81.0 % for tirofiban and 58.6 % for eptifibatide). Evidence from case series and one randomised controlled trial suggests that, in patients with recent coronary stenting undergoing major surgery, perioperative bridge therapy with intravenous antiplatelet agents is an effective and safe treatment option to ensure low rate of ischaemic events.

Original languageEnglish
Pages (from-to)225-235
Number of pages11
JournalInternal and Emergency Medicine
Volume9
Issue number2
DOIs
Publication statusPublished - Mar 2014

Fingerprint

Oral Surgical Procedures
tirofiban
Platelet Aggregation Inhibitors
Confidence Intervals
Hemorrhage
Randomized Controlled Trials
Therapeutics
Perioperative Period
Drug-Eluting Stents
MEDLINE
Libraries
Safety
Drug Therapy
Pharmaceutical Preparations
eptifibatide
cangrelor

Keywords

  • Heart diseases
  • Platelet aggregation inhibitors
  • Stents
  • Surgical procedures

ASJC Scopus subject areas

  • Emergency Medicine
  • Internal Medicine
  • Medicine(all)

Cite this

Bridge with intravenous antiplatelet therapy during temporary withdrawal of oral agents for surgical procedures : A systematic review. / Morici, Nuccia; Moja, Lorenzo; Rosato, Valentina; Sacco, Alice; Mafrici, Antonio; Klugmann, Silvio; D'Urbano, Maurizio; La Vecchia, Carlo; De Servi, Stefano; Savonitto, Stefano.

In: Internal and Emergency Medicine, Vol. 9, No. 2, 03.2014, p. 225-235.

Research output: Contribution to journalArticle

Morici, Nuccia ; Moja, Lorenzo ; Rosato, Valentina ; Sacco, Alice ; Mafrici, Antonio ; Klugmann, Silvio ; D'Urbano, Maurizio ; La Vecchia, Carlo ; De Servi, Stefano ; Savonitto, Stefano. / Bridge with intravenous antiplatelet therapy during temporary withdrawal of oral agents for surgical procedures : A systematic review. In: Internal and Emergency Medicine. 2014 ; Vol. 9, No. 2. pp. 225-235.
@article{b3fdfaa2f3f64cba9046cd51386dfc40,
title = "Bridge with intravenous antiplatelet therapy during temporary withdrawal of oral agents for surgical procedures: A systematic review",
abstract = "Patients needing surgery within 1 year after drug-eluting cardiac stent implantation are challenging to manage because of an increased thrombotic and bleeding risk. A {"}bridge therapy{"} with short-acting antiplatelet agents in the perioperative period is an option. We assessed the outcome and safety of such a bridge therapy in cardiovascular and non-cardiovascular surgery. We performed a comprehensive search of MEDLINE, EMBASE, the Cochrane Library, and ongoing trial registers, irrespective of type of design. Our primary outcome was the success rate of bridge therapy in terms of freedom from cardiac ischaemic adverse events, whereas secondary outcome was freedom from bleeding/transfusion. We also performed combined success rate for each bridge therapy drug (tirofiban, eptifibatide, and cangrelor). We included eight case series and one randomised controlled trial. Among the 420 patients included, the technique was effective 96.2 {\%} of the times [95 {\%} confidence interval (CI) 94.4-98.0 {\%}]. The success rate was 100 {\%} for tirofiban (4 studies), 93.8 {\%} for eptifibatide (4 studies), and 96.2 {\%} for cangrelor (1 study). Freedom from bleeding/transfusion events was observed in 72.6 {\%} of the times (95 {\%} CI 68.4-76.9 {\%}), and was higher with cangrelor (88.7 {\%}; 95 {\%} CI 82.7-94.7 {\%}) than with other drugs (81.0 {\%} for tirofiban and 58.6 {\%} for eptifibatide). Evidence from case series and one randomised controlled trial suggests that, in patients with recent coronary stenting undergoing major surgery, perioperative bridge therapy with intravenous antiplatelet agents is an effective and safe treatment option to ensure low rate of ischaemic events.",
keywords = "Heart diseases, Platelet aggregation inhibitors, Stents, Surgical procedures",
author = "Nuccia Morici and Lorenzo Moja and Valentina Rosato and Alice Sacco and Antonio Mafrici and Silvio Klugmann and Maurizio D'Urbano and {La Vecchia}, Carlo and {De Servi}, Stefano and Stefano Savonitto",
year = "2014",
month = "3",
doi = "10.1007/s11739-013-1041-8",
language = "English",
volume = "9",
pages = "225--235",
journal = "Internal and Emergency Medicine",
issn = "1828-0447",
publisher = "Springer-Verlag Italia s.r.l.",
number = "2",

}

TY - JOUR

T1 - Bridge with intravenous antiplatelet therapy during temporary withdrawal of oral agents for surgical procedures

T2 - A systematic review

AU - Morici, Nuccia

AU - Moja, Lorenzo

AU - Rosato, Valentina

AU - Sacco, Alice

AU - Mafrici, Antonio

AU - Klugmann, Silvio

AU - D'Urbano, Maurizio

AU - La Vecchia, Carlo

AU - De Servi, Stefano

AU - Savonitto, Stefano

PY - 2014/3

Y1 - 2014/3

N2 - Patients needing surgery within 1 year after drug-eluting cardiac stent implantation are challenging to manage because of an increased thrombotic and bleeding risk. A "bridge therapy" with short-acting antiplatelet agents in the perioperative period is an option. We assessed the outcome and safety of such a bridge therapy in cardiovascular and non-cardiovascular surgery. We performed a comprehensive search of MEDLINE, EMBASE, the Cochrane Library, and ongoing trial registers, irrespective of type of design. Our primary outcome was the success rate of bridge therapy in terms of freedom from cardiac ischaemic adverse events, whereas secondary outcome was freedom from bleeding/transfusion. We also performed combined success rate for each bridge therapy drug (tirofiban, eptifibatide, and cangrelor). We included eight case series and one randomised controlled trial. Among the 420 patients included, the technique was effective 96.2 % of the times [95 % confidence interval (CI) 94.4-98.0 %]. The success rate was 100 % for tirofiban (4 studies), 93.8 % for eptifibatide (4 studies), and 96.2 % for cangrelor (1 study). Freedom from bleeding/transfusion events was observed in 72.6 % of the times (95 % CI 68.4-76.9 %), and was higher with cangrelor (88.7 %; 95 % CI 82.7-94.7 %) than with other drugs (81.0 % for tirofiban and 58.6 % for eptifibatide). Evidence from case series and one randomised controlled trial suggests that, in patients with recent coronary stenting undergoing major surgery, perioperative bridge therapy with intravenous antiplatelet agents is an effective and safe treatment option to ensure low rate of ischaemic events.

AB - Patients needing surgery within 1 year after drug-eluting cardiac stent implantation are challenging to manage because of an increased thrombotic and bleeding risk. A "bridge therapy" with short-acting antiplatelet agents in the perioperative period is an option. We assessed the outcome and safety of such a bridge therapy in cardiovascular and non-cardiovascular surgery. We performed a comprehensive search of MEDLINE, EMBASE, the Cochrane Library, and ongoing trial registers, irrespective of type of design. Our primary outcome was the success rate of bridge therapy in terms of freedom from cardiac ischaemic adverse events, whereas secondary outcome was freedom from bleeding/transfusion. We also performed combined success rate for each bridge therapy drug (tirofiban, eptifibatide, and cangrelor). We included eight case series and one randomised controlled trial. Among the 420 patients included, the technique was effective 96.2 % of the times [95 % confidence interval (CI) 94.4-98.0 %]. The success rate was 100 % for tirofiban (4 studies), 93.8 % for eptifibatide (4 studies), and 96.2 % for cangrelor (1 study). Freedom from bleeding/transfusion events was observed in 72.6 % of the times (95 % CI 68.4-76.9 %), and was higher with cangrelor (88.7 %; 95 % CI 82.7-94.7 %) than with other drugs (81.0 % for tirofiban and 58.6 % for eptifibatide). Evidence from case series and one randomised controlled trial suggests that, in patients with recent coronary stenting undergoing major surgery, perioperative bridge therapy with intravenous antiplatelet agents is an effective and safe treatment option to ensure low rate of ischaemic events.

KW - Heart diseases

KW - Platelet aggregation inhibitors

KW - Stents

KW - Surgical procedures

UR - http://www.scopus.com/inward/record.url?scp=84894446075&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84894446075&partnerID=8YFLogxK

U2 - 10.1007/s11739-013-1041-8

DO - 10.1007/s11739-013-1041-8

M3 - Article

C2 - 24419741

AN - SCOPUS:84894446075

VL - 9

SP - 225

EP - 235

JO - Internal and Emergency Medicine

JF - Internal and Emergency Medicine

SN - 1828-0447

IS - 2

ER -