Bridging therapy after recent stent implantation: case report and review of data.
For patients requiring surgery within their first year following coronary stent placement, maximizing the prevention of stent thrombosis with antiplatelet therapy while minimizing the risk of intraoperative bleeding has become a management challenge for cardiologists, surgeons and anesthesiologists. In this manuscript, we describe a case of a patient who received three stents (two of which were drug-eluting) and 7 months later was bridged with intravenous eptifibatide, a short-acting glycoprotein (GP) IIb/IIIa inhibitor, for 3 days prior to bronchoscopy and cervical mediastinoscopy for a suspected lung cancer. We then review the current literature for data and guidelines describing the use of short-acting GP IIb/IIIa as bridge therapy. Finally, we provide recommendations, based on our experience combined with this review, for bridge therapy in the perioperative period for patients with recent coronary stents.
Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Jeffrey D
JD
Wessler
Fidencio
F
Saldana
Robert P
RP
Giugliano
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D054855:Drug-Eluting Stents / Q000009:adverse effects; D000077542:Eptifibatide; D006801:Humans; D008297:Male; D010455:Peptides / Q000627:therapeutic use*; D019990:Perioperative Care; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000627:therapeutic use*; D015607:Stents / Q000009:adverse effects; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control*
D000925:Anticoagulants; D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077542:Eptifibatide