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Urgent surgery in patients with a recently implanted coronary drug-eluting stent: a phase II study of ‘bridging’ antiplatelet therapy with tirofiban during temporary withdrawal of clopidogrel

Savonitto, S. ; D'Urbano, M. ; Caracciolo, M. ; Barlocco, F. ; Mariani, G. ; Nichelatti, M. ; Klugmann, S. ; De Servi, S.

British journal of anaesthesia : BJA, 2010-03, Vol.104 (3), p.285-291 [Periódico revisado por pares]

Oxford: Elsevier Ltd

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Título:
Urgent surgery in patients with a recently implanted coronary drug-eluting stent: a phase II study of ‘bridging’ antiplatelet therapy with tirofiban during temporary withdrawal of clopidogrel
Autor: Savonitto, S. ; D'Urbano, M. ; Caracciolo, M. ; Barlocco, F. ; Mariani, G. ; Nichelatti, M. ; Klugmann, S. ; De Servi, S.
Assuntos: Adult ; Aged ; Aged, 80 and over ; Anesthesia ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Angioplasty, Balloon, Coronary ; Biological and medical sciences ; blood ; Blood Loss, Surgical - prevention & control ; blood, coagulation ; coagulation ; coronary occlusion ; Coronary Restenosis - prevention & control ; Coronary Thrombosis - prevention & control ; Drug Administration Schedule ; Drug-Eluting Stents - adverse effects ; Emergencies ; Female ; heart ; heart, coronary occlusion ; Hemostasis, Surgical - methods ; Humans ; Male ; Medical sciences ; Middle Aged ; Perioperative Care - methods ; Pilot Projects ; Platelet Aggregation Inhibitors - adverse effects ; Platelet Aggregation Inhibitors - therapeutic use ; preoperative period ; Prospective Studies ; Substance Withdrawal Syndrome - drug therapy ; surgery ; surgery, preoperative period ; Ticlopidine - adverse effects ; Ticlopidine - analogs & derivatives ; Tyrosine - analogs & derivatives ; Tyrosine - therapeutic use
É parte de: British journal of anaesthesia : BJA, 2010-03, Vol.104 (3), p.285-291
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Descrição: Patients with a recently implanted coronary drug-eluting stent (DES) who need urgent surgery are at increased risk of surgical bleeding unless clopidogrel is discontinued beforehand, but clopidogrel discontinuation has been associated with a high rate of adverse events due to stent thrombosis. This pilot study tested the hypothesis that the i.v. perioperative administration of the short-acting antiplatelet agent tirofiban allows the safe withdrawal of clopidogrel without increasing the rate of surgical bleeding. Phase II study with a Simon two-stage design. Thirty patients with a recently implanted DES [median (range) 4 (1–12) months] and high-risk characteristics for stent thrombosis underwent urgent major surgery or eye surgery. Clopidogrel was to be withdrawn 5 days before surgery, and tirofiban started 24 h later, continued until 4 h before surgery, and resumed 2 h after surgery until oral clopidogrel was resumed. The use of aspirin was decided by the surgeon. There were no cases of death, myocardial infarction, stent thrombosis, or surgical re-exploration due to bleeding during the index admission, with a risk estimate of 0–11.6% (one-tail 97.5% CI). There was one case of thrombolysis in myocardial infarction (TIMI) major and one of TIMI minor bleeding in the postoperative phase; another four patients were transfused without meeting the TIMI criteria for major or minor bleeding. In patients with a recently implanted DES and high-risk characteristics for stent thrombosis needing urgent surgery, a ‘bridging strategy’ using i.v. tirofiban may allow temporary withdrawal of oral clopidogrel without increasing the risk of bleeding.
Editor: Oxford: Elsevier Ltd
Idioma: Inglês

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Urgent surgery in patients with a recently implanted coronary drug-eluting stent: a phase II study of ‘bridging’ antiplatelet therapy with tirofiban during temporary withdrawal of clopidogrel

Savonitto, S. ; D'Urbano, M. ; Caracciolo, M. ; Barlocco, F. ; Mariani, G. ; Nichelatti, M. ; Klugmann, S. ; De Servi, S.

Oxford: Elsevier Ltd

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