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

Jeremy Warshauer, Vishal G. Patel, Georgios Christopoulos, Anna P. Kotsia, Subhash Banerjee, Emmanouil S. Brilakis

Research output: Contribution to journalArticle

23 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)25-31
Number of pages7
JournalCatheterization and Cardiovascular Interventions
Volume85
Issue number1
DOIs
StatePublished - Jan 1 2015

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Keywords

  • Antiplatelet therapy
  • Bleeding
  • Complications
  • Percutaneous coronary intervention
  • Stent thrombosis
  • Surgery

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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