title: Outcomes of preoperative bridging therapy for patients undergoing surgery after coronary stent implantation: a weighted meta-analysis of 280 patients from eight studies.
abstract: BACKGROUND
  Preoperative bridging with a glycoprotein IIb/IIIa inhibitor is often performed in patients with prior coronary stents undergoing surgery who require antiplatelet therapy discontinuation, but its safety and efficacy have received limited study. We performed a weighted meta-analysis of the outcomes in patients with coronary stents undergoing bridging with glycoprotein IIb/IIIa inhibitors prior to surgery.
  
  
  METHODS
  We conducted a weighted meta-analysis of preoperative bridging studies published between 2002 and 2013 in patients with coronary stents undergoing surgery. Data on in-hospital mortality, stent thrombosis, bleeding, hemoglobin decrease, blood transfusion, time to hospital discharge and myocardial infarction were collected.
  
  
  RESULTS
  A total of eight studies with 280 patients were included. Pooled estimates of outcomes were as follows: in-hospital mortality 3.5% (95% confidence interval [CI] 1.7-5.9%); stent thrombosis 1.3% (95% CI 0.3-3.0%); major bleeding 7.4% (95% CI 2.8-14.1%); any bleeding 20.6% (95% CI 4.8-43.2%); mean decrease in hemoglobin 2.8 g/dL (95% CI 2.5-3.0 g/dL); mean blood loss 271 mL (95% CI 211-311 mL); blood transfusion 13.9% (95% CI 1.0-38.2%); time to hospital discharge 5.9 days (95% CI 4.4-7.3 days); and myocardial infarction 1.6% (95% CI 0.3-3.6%).
  
  
  CONCLUSIONS
  Preoperative bridging with a glycoprotein IIb/IIIa inhibitor in patients undergoing surgery after coronary stenting does not abolish the risk of perioperative stent thrombosis and may carry increased risk for bleeding. © 2014 Wiley Periodicals, Inc.
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Warshauer
authors.forename: Vishal G
authors.initials: VG
authors.lastname: Patel
authors.forename: Georgios
authors.initials: G
authors.lastname: Christopoulos
authors.forename: Anna P
authors.initials: AP
authors.lastname: Kotsia
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D003328:Coronary Thrombosis / Q000209:etiology; D004334:Drug Administration Schedule; D006470:Hemorrhage / Q000139:chemically induced / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D009203:Myocardial Infarction / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000295:instrumentation* / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex
keywords: antiplatelet therapy; bleeding; complications; percutaneous coronary intervention; stent thrombosis; surgery