Intravenous Antiplatelet Therapy Bridging in Patients Undergoing Cardiac or Non-Cardiac Surgery Following Percutaneous Coronary Intervention

Dargham, Bassel Bou; Baskar, Amutharani; Tejani, Ishita; Cui, Zhonghao; Chauhan, Siddarth; Sum-Ping, John; Weideman, Rick; Banerjee, Subhash

doi:10.1016/j.carrev.2018.11.018

Cited by 14 publications

(7 citation statements)

References 25 publications

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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%

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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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Section: Discussionmentioning

confidence: 99%

Section: Table 4 (Continued)mentioning

confidence: 99%

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

Salgia

Gillette

2022

Ann Pharmacother

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“…In another study it has been reported that thrombotic events start in the preoperative period (8). Bridging with intravenous glycoprotein IIb/IIIa inhibitors (eptifibatide, tirofiban) with a short half-life has been suggested for these patients in recent years (9,10).…”

Section: Discussionmentioning

confidence: 99%

Kalça kırığı cerrahisi geçiren yaşlı hastalarda uzun dönem antitrombotik tedavilerin perioperatif morbidite ve mortalite üzerine etkisi

CERAN¹,

LAFÇI

AYTAÇ

et al. 2022

Genel Tıp Dergisi

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ABSTRACT Objective: Ischemic complications or massive bleeding are important perioperative complications in elderly patients using antithrombotic drugs. The need for blood product replacement, transfusion-related complications, prolonged stay in hospital and intensive care unit, and high mortality in the perioperative period can be seen. The aim of this study was to investigate the effects of long-term different antithrombotic therapies on morbidity and mortality in elderly patients undergoing surgery for hip fracture. Materials and Methods: This retrospective cohort study included patients aged 65 years and older who underwent surgery for hip fracture between 2015 and 2018. Patients with no antithrombotic treatment (Group NonAT), warfarin (Group Warfarin), novel oral anticoagulants (Group NOACs), or dual antiplatelet therapy (Group DAPT) were compared in terms of major bleeding, deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE) complications, length of hospital stay (LOS), ICU admission, and 30-day mortality. Results: The study included 668 patients; demographic data in Group NonAT (n=442), Group Warfarin (n=59), Group NOACs (n=30) and Group DAPT(n=137) were similar. Major bleeding and red blood cell transfusion did not differ statistically between all groups. (p>0.05) The preoperative and postoperative Hb values of the patients were not statistically different between the groups (p>0.05). Mortality, only there was statistically significantly higher in the dual antiplatelet group than the non user group. (p0.05) However survival was statistically significant different (p

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“…In fact, it has a very short half-life with rapid resumption of platelet function (within 60 minutes), it does not require renal dosing adjustments and has a specific dosing regimen for bridging identified from a dose-finding investigation aimed at achieving "thienopyridine-like" levels of platelet inhibition; moreover, cangrelor has been specifically tested in a prospective, randomized, double-blind, placebo-controlled trial of patients undergoing CABG. 9,33 Conversely, the short-acting GPIs (i.e., eptifibatide and tirofiban) have a longer half-life and slower offset of action (i.e., 4-6 hours) compared with cangrelor, require renal dosing adjustments, and are used at the ACS dosing regimen given that there is no dedicated bridging dose. 34 Moreover, GPIs are known to be associated with an increased risk of thrombocytopenia, particularly with prolonged infusion, a phenomenon associated with worse outcomes, including mortality.…”

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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Intravenous Antiplatelet Therapy Bridging in Patients Undergoing Cardiac or Non-Cardiac Surgery Following Percutaneous Coronary Intervention

Cited by 14 publications

References 25 publications

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

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

Kalça kırığı cerrahisi geçiren yaşlı hastalarda uzun dönem antitrombotik tedavilerin perioperatif morbidite ve mortalite üzerine etkisi

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

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