title: Bleeding risk associated with eptifibatide (Integrilin) bridging in thoracic surgery patients.
abstract: Antiplatelet use for treatment of coronary artery disease (CAD) is common amongst thoracic surgery patients. Perioperative management of antiplatelet agents requires balancing the opposing risks of myocardial ischemia and excessive bleeding. Perioperative bridging with short-acting intravenous antiplatelet agents has shown promise in preventing myocardial ischemia, but may increase bleeding. We sought to determine whether perioperative bridging with eptifibatide increased bleeding associated with thoracic surgery. After Institutional Review Board approval, we identified thoracic surgery patients receiving eptifibatide at our institution (n = 30). These patients were matched 1:2 with control patients with CAD who did not receive eptifibatide from an institutional database of general thoracic surgery patients. The primary endpoint for our study was the number of units of blood transfused perioperatively. There were no differences in our primary endpoint, number of units of blood products transfused. There were also no differences noted between groups in intraoperative blood loss, chest tube duration, or postoperative length of stay (LOS). While there were no difference noted in overall complications, including our outcome of perioperative MI or death, composite cardiovascular events were more common in the eptifibatide group. In our retrospective exploratory analysis, eptifibatide bridging in patients with high-risk or recent PCI was not associated with an increased need for perioperative transfusion, bleeding, or increased LOS. In addition, we found a similar rate of perioperative mortality or myocardial infarction in both groups, though the ability of eptifibatide to protect against perioperative myocardial ischemia is unclear given different baseline CAD characteristics.
authors: Department of Anesthesiology, Duke University Medical Center, Durham, NC, 27710, USA. nathan.waldron@dm.duke.edu.
authors: Nathan H
authors: http://orcid.org/0000-0002-1430-8204
authors: NH
authors: Waldron
authors: Department of Anesthesiology, San Antonio Military Medical Center, Fort Sam Houston, TX, 78234, USA.
authors: Torijaun
authors: T
authors: Dallas
authors: Department of Surgery, The City of Hope Cancer Center, Duarte, CA, 91010, USA.
authors: Loretta
authors: L
authors: Erhunmwunsee
authors: Department of Cardiology, Duke University Medical Center, Durham, NC, 27710, USA.
authors: Tracy Y
authors: TY
authors: Wang
authors: Department of Surgery, Stanford University Medical Center, Stanford, CA, 94305, USA.
authors: Mark F
authors: MF
authors: Berry
authors: Department of Anesthesiology, Duke University Medical Center, Durham, NC, 27710, USA.
authors: Ian J
authors: IJ
authors: Welsby
mesh_terms: D000368:Aged; D001803:Blood Transfusion / Q000706:statistics & numerical data; D016022:Case-Control Studies; D003324:Coronary Artery Disease; D000077542:Eptifibatide; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia; D010455:Peptides / Q000009:adverse effects* / Q000627:therapeutic use; D059035:Perioperative Period; D012189:Retrospective Studies; D019616:Thoracic Surgical Procedures / Q000009:adverse effects*
chemical_list: D010455:Peptides; D000077542:Eptifibatide
keywords: Antiplatelet; Bridging; Coronary artery disease; Perioperative; Thoracic surgery