Antiplatelet therapy and outcome in patients undergoing surgery following coronary stenting: Results of the surgery after stenting registry

Rossini, Roberta; Angiolillo, Dominick J.; Musumeci, Giuseppe; Capodanno, Davide; Lettino, Maddalena; Trabattoni, Daniela; Pilleri, Annarita; Calabria, Paolo; Colombo, Paola; Bernabò, Paola; Ferlini, Marco; Ferri, Marco; Tarantini, Giuseppe; Servi, Stefano De; Savonitto, Stefano

doi:10.1002/ccd.26629

Cited by 23 publications

(10 citation statements)

References 36 publications

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“…Risk prediction models, such as the CHADS 2 score (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke [double weight]), have been assessed in a perioperative setting but in patients with atrial fibrillation in whom the assessment was for stroke prediction and not acute coronary events. 23 Risk stratification should be individualized so as to consider the following factors 24 : 1) time interval from stent implantation to surgery; 2) type of surgery (cardiovascular vs noncardiovascular site, bleeding risk); 3) stent characteristics (location, length, diameter); 4) other patient characteristics (prior acute coronary syndrome, left ventricular dysfunction, peripheral arterial disease, smoking). Of these factors, the type of surgery is an overlooked but important determinant.…”

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confidence: 99%

Perioperative management of patients who are receiving antiplatelet therapy: a case-based, evidence-informed approach

Douketis¹,

Darvish-Kazem²,

Spencer³

et al. 2018

Polish Archives of Internal Medicine

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REVIEW ARTICLE Perioperative management of patients receiving antiplatelet therapy 771 Clinical scenarios Case 1 A 76 -year -old female with hypertension, type 2 diabetes, and stable angina, with no prior coronary stents or coronary artery bypass graft (CABG) surgery, is scheduled for an elective outpatient laparoscopic hernia repair. She is receiving ASA, 81 mg/d, and is referred to the perioperative risk assessment and management clinic.Case 2 A 59 -year -old male who has smoked for 40 years suffered an anterior wall ST -segment elevation myocardial infarction (MI) that required implantation of a drug -eluting coronary stent in the left anterior descending coronary artery. He is now receiving dual antiplatelet therapy with ASA, 81 mg/d, and clopidogrel, 75 mg/d. A routine chest X -ray showed a suspicious coin lesion, which was subsequently diagnosed, 4 weeks after his MI, as squamous cell lung cancer. A lobectomy is recommended.

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confidence: 99%

Perioperative management of patients who are receiving antiplatelet therapy: a case-based, evidence-informed approach

Douketis¹,

Darvish-Kazem²,

Spencer³

et al. 2018

Polish Archives of Internal Medicine

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“…4,25,31,32 In this setting, a strategy of temporary transition with a potent and effective intravenous antiplatelet agent with a predictable and safe interruption of platelet inhibition may represent an appropriate treatment option. [4][5][6] Currently, the only intravenous antiplatelet agents available for clinical use and potentially usable for bridging include cangrelor and glycoprotein IIb/IIIa inhibitors (GPI). However, cangrelor is a more attractive agent for bridging.…”

Section: Discussionmentioning

confidence: 99%

Antiplatelet Therapy with Cangrelor in Patients Undergoing Surgery after Coronary Stent Implantation: A Real-World Bridging Protocol Experience

Rossini

Masiero

Fruttero

et al. 2020

TH Open

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Objective The aim of the study is to describe the real-world use of the P2Y12 inhibitor cangrelor as a bridging strategy in patients at high thrombotic risk after percutaneous coronary intervention (PCI) and referred to surgery requiring perioperative withdrawal of dual antiplatelet therapy (DAPT). Materials and Methods We collected data from nine Italian centers on patients with previous PCI who were still on DAPT and undergoing nondeferrable surgery requiring DAPT discontinuation. A perioperative standardized bridging protocol with cangrelor was used. Results Between December 2017 and April 2019, 24 patients (mean age 72 years; male 79%) were enrolled. All patients were at high thrombotic risk after PCI and required nondeferrable intermediate to high bleeding risk surgery requiring DAPT discontinuation (4.6 ± 1.7 days). Cangrelor infusion was started at a bridging dose (0.75 µg/kg/min) 3 days before planned surgery and was discontinued 6.6 ± 1.5 hours prior to surgical incision. In 55% of patients, cangrelor was resumed at 9 ± 6 hours following surgery for a mean of 39 ± 38 hours. One cardiac death was reported after 3 hours of cangrelor discontinuation prior to surgery. No ischemic outcomes occurred after surgery and up to 30-days follow-up. The mean hemoglobin drop was <2 g/dL; nine patients received blood transfusions consistent with the type of surgery, but no life-threatening or fatal bleeding occurred. Conclusion Perioperative bridging therapy with cangrelor is a feasible approach for stented patients at high thrombotic risk and referred to surgery requiring DAPT discontinuation. Larger studies are warranted to support the safety of this strategy.

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“…Based on these two studies, ACC/AHA 2014 guidelines and 2016 focused update commented that elective noncardiac surgery after DES implantation may be considered after 180 days 3 , 4 . Rossini and colleagues 23 performed an analysis of multicenter, prospective registry of 1082 patients with previous coronary stent insertion. Surgeries performed within 180 days from PCI were associated with net-adverse clinical events, but not with MACE.…”

Section: Discussionmentioning

confidence: 99%

“…Sixthly, the definition of bleeding outcome may influence our results. The definition of major bleeding from the POISE-2 trial may not be a broadly accepted scale and using another scale may lead to different results 23 , 24 .…”

Section: Discussionmentioning

confidence: 99%

Risk of non-cardiac surgery after percutaneous coronary intervention with drug-eluting stents

Park

Jung

et al. 2017

Sci Rep

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Elective non-cardiac surgery (NCS) should optimally be delayed one year after implantation of a drug-eluting stent (DES). Dual antiplatelet therapy or at least aspirin is recommended to be continued considering the relative risk of stent thrombosis especially during the 4 weeks after DES implantation. However, these recommendations were supported by insufficient evidence. We investigated predictors for postoperative major adverse cardiovascular and cerebral event (MACCE) in 1582 patients undergoing non-cardiac surgery after DES implantation. 96 patients (6.1%) developed postoperative MACCE. In the propensity score-matched analysis, aspirin maintenance was not associated with MACCE (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.48–1.27, P = 0.320) and was associated with increased risk of major bleeding (OR 1.84, 95% CI 1.02–3.32, P = 0.044). When patients who underwent NCS within one month after DES implantation were matched with those who underwent NCS thereafter, the risk of MACCE was higher when surgery was done within 30 days after PCI (OR 2.21, 95% CI 1.05–4.66, P = 0.036). Maintenance of aspirin did not decrease MACCE after NCS in patients with DES and only increased the risk of major bleeding. NCS within one month after DES implantation was associated with higher incidence of MACCE. However, prospective trials are required to validate our results.

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Antiplatelet therapy and outcome in patients undergoing surgery following coronary stenting: Results of the surgery after stenting registry

Abstract: The results of this registry demonstrate the safety and feasibility of applying a national consensus document on the perioperative management of antiplatelet therapy in stented patients undergoing surgery. © 2016 Wiley Periodicals, Inc.

Cited by 23 publications

References 36 publications

Perioperative management of patients who are receiving antiplatelet therapy: a case-based, evidence-informed approach

Perioperative management of patients who are receiving antiplatelet therapy: a case-based, evidence-informed approach

Antiplatelet Therapy with Cangrelor in Patients Undergoing Surgery after Coronary Stent Implantation: A Real-World Bridging Protocol Experience

Risk of non-cardiac surgery after percutaneous coronary intervention with drug-eluting stents

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