Bridging with glycoprotein IIb/IIIa inhibitors for periprocedural management of antiplatelet therapy in patients with drug eluting stents
Catheterization and Cardiovascular Interventions, 10/14/2011
Morrison TB et al. – In patients with drug eluting stents (DES), who require cessation of clopidogrel before surgery, bridging with GP IIb/IIIa inhibitors appears effective in preventing adverse cardiac outcomes but may be associated with bleeding in patients undergoing cardiac surgery.Methods
- A pharmacy database was used to identify GP IIb/IIIa inhibitor orders at the hospital between January 1, 2007 and July 31, 2009.
- Indication for GP IIb/IIIa inhibitor administration and other clinical data were gathered through retrospective review of medical records.
- End points assessed were stent thrombosis, major bleeding, minor bleeding, postoperative acute coronary syndrome, and death within 30 days.
- 4176 separate orders for GP IIb/IIIa inhibitors were identified (January 1, 2007 to July 31, 2009).
- 6 patients underwent non–cardiac and thirteen underwent cardiac surgery.
- Clopidogrel was discontinued a median of 6 days before surgery and 2 days prior to initiating GP IIb/IIIa inhibitor.
- All bridging patients were treated with eptifibatide infusion prior to procedure.
- There were no stent thromboses, deaths, or acute coronary syndrome events.
- Major bleeding occurred in 7 (53.9%) cardiac surgery patients and none of the non–cardiac surgery patients, while minor bleeding occurred in 1 (7.7%) and 1 (16.6%) patients, respectively.