title: Bridge with intravenous antiplatelet therapy during temporary withdrawal of oral agents for surgical procedures: a systematic review.
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.
authors.affiliation: Divisione di Cardiologia 1-Emodinamica, Dipartimento Cardio-toraco-vascolare "A. De Gasperis", Azienda Ospedaliera Ospedale Niguarda Cà Granda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy, nuccia.morici@ospedaleniguarda.it.
authors.forename: Nuccia
authors.initials: N
authors.lastname: Morici
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Moja
authors.forename: Valentina
authors.initials: V
authors.lastname: Rosato
authors.forename: Alice
authors.initials: A
authors.lastname: Sacco
authors.forename: Antonio
authors.initials: A
authors.lastname: Mafrici
authors.forename: Silvio
authors.initials: S
authors.lastname: Klugmann
authors.forename: Maurizio
authors.initials: M
authors.lastname: D'Urbano
authors.forename: Carlo
authors.initials: C
authors.lastname: La Vecchia
authors.forename: Stefano
authors.initials: S
authors.lastname: De Servi
authors.forename: Stefano
authors.initials: S
authors.lastname: Savonitto
mesh_terms: D000284:Administration, Oral; D003331:Coronary Vessels / Q000601:surgery*; D054855:Drug-Eluting Stents; D006801:Humans; D007262:Infusions, Intravenous; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D013514:Surgical Procedures, Operative; D013997:Time Factors; D028761:Withholding Treatment
chemical_list: D010975:Platelet Aggregation Inhibitors