title: Outcomes of a preoperative "bridging" strategy with glycoprotein IIb/IIIa inhibitors to prevent perioperative stent thrombosis in patients with drug-eluting stents who undergo surgery necessitating interruption of thienopyridine administration.
abstract: OBJECTIVE
  Surgery after drug-eluting stent (DES) implantation may be associated with increased risk for perioperative stent thrombosis (ST).
  
  
  RESULTS
  We evaluated the outcomes of 67 patients who underwent non-cardiac (n=51) or cardiac (n=16) surgery after DES implantation at our institution between 2008 and 2010 and who underwent preoperative "bridging" with a glycoprotein IIb/IIIa inhibitor. Surgery occurred after a mean time of 13.9 ± 1.7 and 8.7 ± 2 months post stenting for non-cardiac (NCS) and cardiac surgery, respectively. Glycoprotein IIb/IIIa inhibitors were administered preoperatively for a mean of 7.1 ± 0.4 and 7.8 ± 0.7 days, respectively, then discontinued four to six hours before surgery. Most patients received aspirin through the perioperative period (33 NCS patients and 15 cardiac surgery patients). Clopidogrel was restarted as early as possible in the postoperative period. In the non-cardiac surgery group, two patients (3.9%, 95% confidence intervals 0.5% to 13.5%) suffered acute ST in the immediate postoperative period and four patients suffered major bleeding by the Global Utilisation of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO) criteria. One cardiac surgery patient had probable ST one hour postoperatively.
  
  
  CONCLUSIONS
  In spite of preoperative "bridging" with a glycoprotein IIb/IIIa inhibitor, postoperative stent thrombosis can still occur in patients with prior DES undergoing surgery requiring antiplatelet medication interruption.
authors: Department of Cardiovascular Diseases, VA North Texas Health Care System, Dallas, TX 75216, USA.
authors: Laith I
authors: LI
authors: Alshawabkeh
authors: Amit
authors: A
authors: Prasad
authors: Fima
authors: F
authors: Lenkovsky
authors: Laila F
authors: LF
authors: Makary
authors: Enas S
authors: ES
authors: Kandil
authors: Rick A
authors: RA
authors: Weideman
authors: Kevin C
authors: KC
authors: Kelly
authors: Bavana V
authors: BV
authors: Rangan
authors: Subhash
authors: S
authors: Banerjee
authors: Emmanouil S
authors: ES
authors: Brilakis
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D003328:Coronary Thrombosis / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D004334:Drug Administration Schedule; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation*; D019990:Perioperative Care; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D011474:Prosthesis Design; D011725:Pyridines / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies; D013781:Texas; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D011725:Pyridines; C446540:thienopyridine