Initial experience with an institutional bridging protocol for patients with recent coronary stent implantation requiring discontinuation of dual antiplatelet therapy resulting from urgent surgery.
Patients that receive coronary bare-metal or drug-eluting stents have to be maintained on dual antiplatelet therapy (DAPT) for at least 4 weeks or 12 months, respectively. The prolonged time period required for drug-eluting stents is the result of delayed vascular healing that is associated with the drug and the polymeric coating. Premature cessation of DAPT may precipitate life-threatening stent thrombosis. However, some urgent, unplanned surgical procedures cannot be carried out under DAPT as a result of an unacceptable bleeding risk. Therefore, in these particular patients, DAPT therapy needs to be bridged for urgent surgery to avoid stent thrombosis, yet no clinical recommendation about a specific pharmacologic protocol is currently available for this specific purpose. We report about the initial experience with a novel institutional bridging protocol using bivalirudin that has been developed and applied successfully in a limited number of patients.
Wessely
Rainer
R
Department of Cardiology and Angiology, Ev. Bethesda-Johanniter-Klinikum, Duisburg, Germany. rwessely@web.de
D000991:Antithrombins / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D016063:Blood Loss, Surgical / Q000517:prevention & control; D000077144:Clopidogrel; D003328:Coronary Thrombosis / Q000517:prevention & control*; D054855:Drug-Eluting Stents; D006629:Hirudins; D006801:Humans; D010446:Peptide Fragments / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D011994:Recombinant Proteins / Q000627:therapeutic use; D015607:Stents; D013514:Surgical Procedures, Operative / Q000379:methods; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D013997:Time Factors
D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D010975:Platelet Aggregation Inhibitors; D011994:Recombinant Proteins; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin; C074619:bivalirudin