Why the study?
When non-cardiac surgery is required within 6 months of coronary stent implantation on DAPT, balancing ischemic and haemorrhagic risks presents serious clinical challenges.
Does bridging with intravenous tirofiban prevent ischemic complications without excessive bleeding in high-risk patients on DAPT requiring urgent non-cardiac surgery?
Does bridging with intravenous tirofiban prevent ischemic complications without excessive bleeding in high-risk patients on DAPT requiring urgent non-cardiac surgery?
Bridging with intravenous tirofiban during temporary P2Y12 inhibitor withdrawal appears safe and effective for patients at high ischemic risk requiring urgent non-cardiac surgery shortly after coronary stenting.
Answers are grounded in this paper and cite their sources.
May support bridging in select high-risk post-stent cases needing early surgery; leaves open prospective validation before practice change.
Background: Recent coronary stent implantation requires Dual Antiplatelet Therapy (DAPT) for at least 6 months. Serious issues are raised when non-cardiac surgery is required during this period, because of the balance between ischemic and haemorrhagic complications. Case Reports: We report 2 high ischemic risk cases requiring intermediate bleeding risk non-cardiac surgery, during the first month of DAPT initiation. Perioperative management with discontinuation of the P2Y12 inhibitor and bridging with tirofiban, while aspirin was uninterrupted, was uneventful. Conclusion: Bridging with intravenous glycoprotein IIb/IIIa receptor inhibitors may be a safe and effective alternative to P2Y12 inhibitor discontinuation in non-deferrable non-cardiac surgery.
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Vlachou et al. (2019) studied this question.
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