Outcomes of a preoperative “bridging” strategy with glycoprotein IIb/IIIa inhibitors to prevent perioperative stent thrombosis in patients with drug-eluting stents who undergo surgery necessitating interruption of thienopyridine administration

Objective: To evaluate the outcomes after preoperative administration of a glycoprotein IIb/IIIa inhibitor in patients with prior drug-eluting stent (DES) implantation who required surgery necessitating interruption of thienopyridine administration. Background: Surgery after DES implantation may be associated with increased risk for perioperative stent thrombosis Methods: We evaluated the outcomes of 67 consecutive patients who underwent noncardiac (n=51) or cardiac (n=16) surgery after DES implantation at our institution between 2008 and 2010 and underwent preoperative “bridging” with a glycoprotein IIb/IIIa inhibitor. Results: Mean age was 65±1.2 years and all patients were men. Surgery occurred after a mean time of 13.9±1.7 and 8.7±2 months post stenting for noncardiac and cardiac surgery respectively. A glycoprotein IIb/IIIa inhibitor was administered preoperatively for a mean of 7.1±0.4 and 7.8±0.7 days, respectively then discontinued 4 hours before surgery. The majority of patients continued to receive aspirin through the perioperative period (33 patients for NCS group and 15 patients for cardiac surgery group). Clopidogrel was restarted as early as possible in the postoperative period. Among patients undergoing noncardiac surgery, two patients (3.9%, 95% confidence intervals 0.5%, 13.5%) had acute stent thrombosis in the immediate postoperative period and four patients had major bleeding by the GUSTO criteria. One of the cardiac surgery patients had probable stent thrombosis one hour post surgery. Conclusions: Preoperative “bridging” with a glycoprotein IIb/IIIa inhibitor may not prevent postoperative stent thrombosis in patients with prior DES undergoing surgery requiring antiplatelet medication interruption.