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

Keywords

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

ASJC Scopus subject areas

  • Emergency Medicine
  • Internal Medicine
  • Medicine(all)

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