A Novel Bridging Strategy for Patients Undergoing Emergent Non-Cardiac Surgery with a Recent Coronary Stent

Bruck, Cierra; Jafar, Omar; Prats, Jayne; Bhatt, Deepak L.; Jafar, Zubair

doi:10.1007/s40119-018-0113-2

Cited by 3 publications

(5 citation statements)

References 4 publications

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“…To date, a number of case studies have evaluated the use of cangrelor in bridging for both high-risk and lowrisk procedures. The endpoint assessed is usually thrombotic events and/or bleeding, and the studies show that cangrelor was employed and discontinued without causing complications [15][16][17][18][19]. Specifically, Bowman et al evaluated the use of cangrelor as bridging therapy for surgical procedures in 11 patients with a history of coronary stents, finding that bleeding complications occurred in three of the patients and no in-stent thromboses occurred [15].…”

Section: Discussionmentioning

confidence: 99%

“…Specifically, Bowman et al evaluated the use of cangrelor as bridging therapy for surgical procedures in 11 patients with a history of coronary stents, finding that bleeding complications occurred in three of the patients and no in-stent thromboses occurred [15]. A number of case reports evaluated low-risk procedures [16][17][18]. In one case, a patient on aspirin and ticagrelor following placement of a drug-eluting stent underwent a bronchoscopy, and cangrelor was used as bridging therapy successfully without thrombotic or bleeding complications [17].…”

Section: Discussionmentioning

confidence: 99%

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Urgent Revascularization of the Left Proximal Circumflex Following Cessation of Cangrelor Within Six Hours of Procedure

Huang,

Rodriguez,

Shakfeh

et al. 2023

Cureus

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Patients undergoing procedures are often transitioned off anticoagulants using anti-platelet agents with short half-lives as a "bridge." We present the case of a patient with a history of in-stent thromboses who experienced a thrombotic event following a literature-guided bridging protocol. This case is one of the first to show that stopping cangrelor within six hours led to a need for urgent revascularization and suggests that the timing for discontinuing bridging agents should be customized based on the patient's history of increased blood clotting.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Urgent Revascularization of the Left Proximal Circumflex Following Cessation of Cangrelor Within Six Hours of Procedure

Huang,

Rodriguez,

Shakfeh

et al. 2023

Cureus

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“…8 Retrospective studies of cangrelor bridging for NCS report either no bleeding or minor procedural bleeding (Table 4), suggesting that this is a safe approach to perioperative platelet inhibition. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, the BRIDGE trial reported a low incidence of preoperative ischemic events, and retrospective studies of cangrelor bridging for NCS report a low incidence of perioperative MACE (Table 4). 8,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Thus, cangrelor bridging appears to be an effective approach for mitigating the risk of perioperative MACE.…”

Section: Table 4 (Continued)mentioning

confidence: 99%

“…Patient selection and bridging practices vary somewhat across studies, though the literature consistently reports a low incidence of perioperative bleeding and ischemic events. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Although an international consensus statement provides guidance on using cangrelor for off-label perioperative bridging, there remain areas of uncertainty. 10 It is not fully known whether the VerifyNow PRUTest of platelet reactivity can be used to guide timing of cangrelor after oral washout.…”

Section: Table 4 (Continued)mentioning

confidence: 99%

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Perioperative Antiplatelet Bridging With Cangrelor: A Cohort Study and Narrative Review

Salgia

Gillette

2022

Ann Pharmacother

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Background: In patients who received a cardiac stent, practice guidelines recommend dual antiplatelet therapy (DAPT). However, an urgent procedure may be required necessitating interruption of DAPT. Intravenous cangrelor was previously shown to be an alternative due its short-half life and quick onset/offset. Objective: To determine the safety and effectiveness of cangrelor bridging for patients undergoing invasive procedures in a veteran population. Methods: Retrospective cohort of patients from Michael E. DeBakey VA Medical Center and the VA North Texas Health Care Systems who underwent perioperative cangrelor bridging. The primary outcome was the incidence of bleeding using the Bleeding Academic Research Consortium (BARC) criteria. The secondary outcome was a composite of nonfatal stroke, myocardial infarction (MI), mortality, and unplanned revascularization within 30 days. A narrative review was also performed to summarize cangrelor bridging for noncardiac invasive procedure. Results: There were 41 patients that met the eligibility criteria. Patients were predominantly Caucasian (57.5%) men with a median age of 70 years. The median duration on cangrelor bridging was 2.6 days with 11 and 30 patients undergoing cardiac and noncardiac invasive procedures, respectively. Nine patients (22%) had a bleeding event of which 8 were minor. One was severe due to significant iliopsoas hematoma following drain placement. All bleeding events occurred postoperatively except for 2 perioperative events that occurred during orthopedic procedures. Ischemic events up to 30 days occurred in 3 patients (7.3%) which consisted of 1 (2.4%) nonfatal MI requiring revascularization and 2 (4.9%) deaths, 1 of which was sudden cardiac. Conclusion and Relevance: This study suggests that cangrelor bridging may be a reasonable alternative to holding oral P2Y12 inhibitors in patients requiring interruption of antiplatelet therapy for an urgent surgery/invasive procedure.

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Antiplatelet Therapy And Percutaneous Coronary Interventions

Davanzo

Alarcon

Calquin

et al. 2021

CCR

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: Dual antiplatelet therapy is one of the cornerstones of modern percutaneous coronary interventions. The development of new therapeutic agents has significantly reduced ischemic events at the risk of increased bleeding complications. Therefore, efforts are currently focused on optimizing therapeutic algorithms to obtain the greatest anti-thrombotic benefit associated with the lowest risk of bleeding, that is, the greater net clinical benefit. A significant number of trials evaluating different drug combinations or adjustments in treatment duration have been completed. However, clinical translation of these results is often difficult, due to the heterogeneity of the therapeutic approaches. The aim of this manuscript is to provide an updated review of the literature regarding the use of dual antiplatelet therapy in patients undergoing coronary angioplasty and stenting.

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A Novel Bridging Strategy for Patients Undergoing Emergent Non-Cardiac Surgery with a Recent Coronary Stent

Cited by 3 publications

References 4 publications

Urgent Revascularization of the Left Proximal Circumflex Following Cessation of Cangrelor Within Six Hours of Procedure

Urgent Revascularization of the Left Proximal Circumflex Following Cessation of Cangrelor Within Six Hours of Procedure

Perioperative Antiplatelet Bridging With Cangrelor: A Cohort Study and Narrative Review

Antiplatelet Therapy And Percutaneous Coronary Interventions

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