title: Safety of "bridging" with eptifibatide for patients with coronary stents before cardiac and non-cardiac surgery.
abstract: Patients with previously implanted coronary stents are at risk for stent thrombosis if dual-antiplatelet therapy is prematurely discontinued. Bridging with a glycoprotein IIb/IIIa inhibitor has been advocated as an alternative, with few supporting data. The aim of this study was to determine the safety of such a strategy by retrospectively analyzing bleeding in 100 consecutive patients with previously implanted coronary stents who were bridged to surgery with eptifibatide after discontinuing thienopyridine therapy. A propensity-matched control comparison was performed for a subgroup of 71 patients who underwent cardiovascular surgery. Blood transfusions were required in 65% in the bridged group versus 66% in the control group (p = 0.86). The mean numbers of units transfused were 4.84 ± 6.93 and 3.65 ± 7.46, respectively (p >0.25). Rates of return to the operating room for bleeding or tamponade were 10% and 2.9%, respectively (p = 0.085). Increased rates of transfusion were noted for patients who received concomitant aspirin and/or intravenous heparin infusion. In conclusion, there does not appear to be any increase in the need for blood transfusions or rate of return to the operating room for patients being bridged with eptifibatide when thienopyridines are discontinued in the perioperative period, but concomitant use of additional antiplatelet or anticoagulant agents may increase transfusions and delays to surgery. Clinicians who are considering this strategy must weigh the risks of stent thrombosis versus bleeding.
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Rassi
authors.forename: Eugene
authors.initials: E
authors.lastname: Blackstone
authors.forename: Michael A
authors.initials: MA
authors.lastname: Militello
authors.forename: Gus
authors.initials: G
authors.lastname: Theodos
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Cavender
authors.forename: Zhiyuan
authors.initials: Z
authors.lastname: Sun
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Ellis
authors.forename: Leslie
authors.initials: L
authors.lastname: Cho
mesh_terms: D000368:Aged; D001241:Aspirin / Q000008:administration & dosage; D001803:Blood Transfusion; D013504:Cardiovascular Surgical Procedures / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D003328:Coronary Thrombosis / Q000209:etiology / Q000517:prevention & control*; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D000077542:Eptifibatide; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology / Q000209:etiology; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000008:administration & dosage / Q000009:adverse effects*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000008:administration & dosage / Q000009:adverse effects / Q000037:antagonists & inhibitors; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies
chemical_list: D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D006493:Heparin; D000077542:Eptifibatide; D001241:Aspirin