Bridging Therapy in the Perioperative Management of Patients With Drug-Eluting Stents

Patients with drug-eluting stents appear to be at increased risk of thrombosis beyond 30 days (late) or even 1 year (very late) after stent placement. Patients with recent placement of drug-eluting stents who are receiving dual-antiplatelet therapy pose a challenge in the perioperative period. Current guidelines recommend discontinuation of clopidogrel 5 to 7 days prior to surgery or invasive procedures to prevent bleeding complications. When a patient with a drug-eluting stent is off of clopidogrel, he or she is at risk of stent thrombosis, even during treatment with anticoagulants, such as intravenous heparin. There are currently no universal recommendations for decreasing the risk of stent thrombosis. We herein outline a strategy involving the use of glycoprotein IIb/IIIa inhibitors as "bridging therapy" during the high-risk perioperative period and report on 8 patients who successfully underwent bridging therapy with no adverse cardiac outcomes (death, myocardial infarction, or stent thrombosis) or bleeding complications.