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Catheter Cardiovasc Interv. 2015 Jan 1;85(1):25-31. doi: 10.1002/ccd.25507. Epub 2014 May 6.

Outcomes of preoperative bridging therapy for patients undergoing surgery after coronary stent implantation: A weighted meta-analysis of 280 patients from eight studies.

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  • 1VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas.

Abstract

BACKGROUND:

Preoperative bridging with a glycoprotein IIb/IIIa inhibitor is often performed in patients with prior coronary stents undergoing surgery who require antiplatelet therapy discontinuation, but its safety and efficacy have received limited study. We performed a weighted meta-analysis of the outcomes in patients with coronary stents undergoing bridging with glycoprotein IIb/IIIa inhibitors prior to surgery.

METHODS:

We conducted a weighted meta-analysis of preoperative bridging studies published between 2002 and 2013 in patients with coronary stents undergoing surgery. Data on in-hospital mortality, stent thrombosis, bleeding, hemoglobin decrease, blood transfusion, time to hospital discharge and myocardial infarction were collected.

RESULTS:

A total of eight studies with 280 patients were included. Pooled estimates of outcomes were as follows: in-hospital mortality 3.5% (95% confidence interval [CI] 1.7-5.9%); stent thrombosis 1.3% (95% CI 0.3-3.0%); major bleeding 7.4% (95% CI 2.8-14.1%); any bleeding 20.6% (95% CI 4.8-43.2%); mean decrease in hemoglobin 2.8 g/dL (95% CI 2.5-3.0 g/dL); mean blood loss 271 mL (95% CI 211-311 mL); blood transfusion 13.9% (95% CI 1.0-38.2%); time to hospital discharge 5.9 days (95% CI 4.4-7.3 days); and myocardial infarction 1.6% (95% CI 0.3-3.6%).

CONCLUSIONS:

Preoperative bridging with a glycoprotein IIb/IIIa inhibitor in patients undergoing surgery after coronary stenting does not abolish the risk of perioperative stent thrombosis and may carry increased risk for bleeding. © 2014 Wiley Periodicals, Inc.

© 2014 Wiley Periodicals, Inc.

KEYWORDS:

antiplatelet therapy; bleeding; complications; percutaneous coronary intervention; stent thrombosis; surgery

PMID:
24740634
[PubMed - in process]
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