Bridging Antiplatelet Therapy After Percutaneous Coronary Intervention: JACC Review Topic of the Week.

Journal Article (Journal Article;Systematic Review)

Patients undergoing early surgery after coronary stent implantation are at increased risk for mortality from ischemic and hemorrhagic complications. The optimal antiplatelet strategy in patients who cannot discontinue dual antiplatelet therapy (DAPT) before surgery is unclear. Current guidelines, based on surgical and clinical characteristics, provide risk stratification for bridging therapy with intravenous antiplatelet agents, but management is guided primarily by expert opinion. This review summarizes perioperative risk factors to consider before discontinuing DAPT and reviews the data for intravenous bridging therapies. Published reports have included bridging options such as small molecule glycoprotein IIb/IIIa inhibitors (eptifibatide or tirofiban) and cangrelor, an intravenous P2Y12 inhibitor. However, optimal management of these complex patients remains unclear in the absence of randomized controlled data, without which an argument can be made both for and against the use of perioperative intravenous bridging therapy after discontinuing oral P2Y12 inhibitors. Multidisciplinary risk assessment remains a critical component of perioperative care.

Full Text

Duke Authors

Cited Authors

  • Sullivan, AE; Nanna, MG; Wang, TY; Bhatt, DL; Angiolillo, DJ; Mehran, R; Banerjee, S; Cantrell, S; Jones, WS; Rymer, JA; Washam, JB; Rao, SV; Ohman, EM

Published Date

  • October 12, 2021

Published In

Volume / Issue

  • 78 / 15

Start / End Page

  • 1550 - 1563

PubMed ID

  • 34620413

Electronic International Standard Serial Number (EISSN)

  • 1558-3597

Digital Object Identifier (DOI)

  • 10.1016/j.jacc.2021.08.013

Language

  • eng

Conference Location

  • United States