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Outcomes of preoperative bridging therapy for patients undergoing surgery after coronary stent implantation: A weighted meta‐analysis of 280 patients from eight studies
Author(s) -
Warshauer Jeremy,
Patel Vishal G,
Christopoulos Georgios,
Kotsia Anna P.,
Banerjee Subhash,
Brilakis Emmanouil S.
Publication year - 2014
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.25507
Subject(s) - medicine , myocardial infarction , coronary stent , perioperative , confidence interval , surgery , discontinuation , stent , percutaneous coronary intervention , acute coronary syndrome , blood transfusion , thrombosis , restenosis
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.