@article{08e31ec21f2d4331982b4f6fe14d54b8,
title = "Bridging Antiplatelet Therapy After Percutaneous Coronary Intervention: JACC Review Topic of the Week",
abstract = "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.",
keywords = "antiplatelet therapy, bleeding, cangrelor, stent, surgery, thrombosis",
author = "Sullivan, {Alexander E.} and Nanna, {Michael G.} and Wang, {Tracy Y.} and Bhatt, {Deepak L.} and Angiolillo, {Dominick J.} and Roxana Mehran and Subhash Banerjee and Sarah Cantrell and Jones, {W. Schuyler} and Rymer, {Jennifer A.} and Washam, {Jeffrey B.} and Rao, {Sunil V.} and Ohman, {E. Magnus}",
note = "Funding Information: This review was investigator initiated and there was no significant source of funding. Dr Nanna has received grant support from Medtronic Vascular, Inc; and has received consulting honorarium from Boston Scientific. Dr Wang has received research grants to the Duke Clinical Research Institute from Abbott, AstraZeneca, Bristol Myers Squibb, Boston Scientific, Cryolife, Chiesi, Merck, Portola, and Regeneron; and has received consulting honoraria from AstraZeneca, Bristol Myers Squibb, Cryolife, and Novartis. Dr Bhatt has been on the advisory board of Cardax, CellProthera, Cereno Scientific, Elsevier Practice Update Cardiology, Level Ex, Medscape Cardiology, MyoKardia, PhaseBio, PLx Pharma, and Regado Biosciences; on the board of directors of Boston VA Research Institute, Society of Cardiovascular Patient Care, and TobeSoft; has been chair of American Heart Association Quality Oversight Committee; has been on the following data monitoring committees: Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by St Jude Medical, now Abbott), Cleveland Clinic (including for the ExCEED trial, funded by Edwards), Contego Medical (Chair, PERFORMANCE 2), Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine (for the ENVISAGE trial, funded by Daiichi-Sankyo), and Population Health Research Institute; has received honoraria from the American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org , Vice-Chair, ACC Accreditation Committee), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI clinical trial steering committee funded by Boehringer Ingelheim, the AEGIS-II executive committee funded by CSL Behring), Belvoir Publications (Editor-in-Chief, Harvard Heart Letter), Canadian Medical and Surgical Knowledge Translation Research Group (clinical trial steering committees), Duke Clinical Research Institute (clinical trial steering committees, including for the PRONOUNCE trial, funded by Ferring Pharmaceuticals), HMP Global (Editor-in-Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), K2P (Co-Chair, interdisciplinary curriculum), Level Ex, Medtelligence/ReachMD (CME steering committees), MJH Life Sciences, Population Health Research Institute (for the COMPASS operations committee, publications committee, steering committee, and USA national co-leader, funded by Bayer), Slack Publications (Chief Medical Editor, Cardiology Today{\textquoteright}s Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees); other: Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), VA CART Research and Publications Committee (Chair); has received research funding from Abbott, Afimmune, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Cardax, Chiesi, CSL Behring, Eisai, Ethicon, Ferring Pharmaceuticals, Forest Laboratories, Fractyl, Idorsia, Ironwood, Ischemix, Lexicon, Lilly, Medtronic, MyoKardia, Pfizer, PhaseBio, PLx Pharma, Regeneron, Roche, Sanofi, Synaptic, and The Medicines Company; has received royalties from Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald{\textquoteright}s Heart Disease); has been Site Co-Investigator at Biotronik, Boston Scientific, CSI, St Jude Medical (now Abbott), and Svelte; has been trustee at the American College of Cardiology; and provided unfunded research to FlowCo, Merck, Novo Nordisk, and Takeda. Dr Angiolillo has received payment as an individual for the following: 1) consulting fee or honorarium from Abbott, Amgen, Aralez, AstraZeneca, Bayer, Biosensors, Boehringer Ingelheim, Bristol Myers Squibb, Chiesi, Daiichi-Sankyo, Eli Lilly, Haemonetics, Janssen, Merck, PhaseBio, PLx Pharma, Pfizer, Sanofi, and The Medicines Company; and 2) participation in review activities from CeloNova and St Jude Medical; and has received institutional payments for grants from Amgen, AstraZeneca, Bayer, Biosensors, CeloNova, CSL Behring, Daiichi-Sankyo, Eisai, Eli Lilly, Gilead, Idorsia, Janssen, Matsutani Chemical Industry Co, Merck, Novartis, Osprey Medical, Renal Guard Solutions, and the Scott R. MacKenzie Foundation. Dr Banerjee has received honoraria from Medtronic, Cordis, Livmor, and AngioSafe; and has received research grants (institutional) from Boston Scientific Corporation and Chiesi. Dr Rao has received institutional research funding from Bayer, Svelte, and Shockwave Medical. Dr Ohman has received research funding from Abiomed and Chiesi; and has received consulting honoraria from Cara Therapeutics, Cytokinetics, Imbria Pharmaceuticals, Otsuka Pharmaceutical, Milestone Pharmaceuticals, Pfizer, and XyloCor Therapeutics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: {\textcopyright} 2021 American College of Cardiology Foundation",
year = "2021",
month = oct,
day = "12",
doi = "10.1016/j.jacc.2021.08.013",
language = "English (US)",
volume = "78",
pages = "1550--1563",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "15",
}