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

被引：27

作者：

Sullivan, Alexander E. ^{[1
]}

Nanna, Michael G. ^{[2
]}

Wang, Tracy Y. ^{[3
]}

Bhatt, Deepak L. ^{[4
,5
]}

Angiolillo, Dominick J. ^{[6
]}

Mehran, Roxana ^{[7
]}

Banerjee, Subhash ^{[8
]}

Cantrell, Sarah ^{[9
]}

Jones, W. Schuyler ^{[3
]}

Rymer, Jennifer A. ^{[3
]}

Washam, Jeffrey B. ^{[10
]}

Rao, Sunil V. ^{[3
]}

Ohman, E. Magnus ^{[3
]}

机构：

[1] Vanderbilt Univ, Med Ctr, Div Cardiol, Nashville, TN USA

[2] Yale Sch Med, Sect Cardiovasc Med, New Haven, CT USA

[3] Duke Univ, Med Ctr, Div Cardiol, Durham, NC 27708 USA

[4] Brigham & Womens Hosp, Div Cardiol, 75 Francis St, Boston, MA 02115 USA

[5] Harvard Med Sch, Boston, MA 02115 USA

[6] Univ Florida, Div Cardiol, Coll Med Jacksonville, Jacksonville, FL USA

[7] Mt Sinai Hosp, Div Cardiol, New York, NY 10029 USA

[8] Univ Texas Southwestern Med Ctr Dallas, Div Cardiol, Dallas, TX 75390 USA

[9] Duke Univ, Sch Med, Duke Univ Med Ctr Lib Arch, Durham, NC USA

[10] Duke Heart Ctr, Durham, NC USA

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2021年 / 78卷 / 15期

关键词：

antiplatelet therapy; bleeding; cangrelor; stent; surgery; thrombosis; DRUG-ELUTING STENT; GLYCOPROTEIN IIB/IIIA INHIBITORS; URGENT SURGERY; PERIOPERATIVE MANAGEMENT; TEMPORARY WITHDRAWAL; PLATELET INHIBITION; NONCARDIAC SURGERY; ADVERSE EVENTS; CARDIAC EVENTS; RISK;

D O I：

10.1016/j.jacc.2021.08.013

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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 P2Y(12) 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 P2Y(12) inhibitors. Multidisciplinary risk assessment remains a critical component of perioperative care. (C) 2021 by the American College of Cardiology Foundation.

引用

页码：1550 / 1563

页数：14

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