Initial Experience With an Institutional Bridging Protocol for Patients With Recent Coronary Stent Implantation Requiring Discontinuation of Dual Antiplatelet Therapy Resulting From Urgent Surgery

Patients that receive coronary bare-metal or drug-eluting stents have to be maintained on dual antiplatelet therapy (DAPT) for at least 4 weeks or 12 months, respectively. The prolonged time period required for drug-eluting stents is the result of delayed vascular healing that is associated with the drug and the polymeric coating. Premature cessation of DAPT may precipitate life-threatening stent thrombosis. However, some urgent, unplanned surgical procedures cannot be carried out under DAPT as a result of an unacceptable bleeding risk. Therefore, in these particular patients, DAPT therapy needs to be bridged for urgent surgery to avoid stent thrombosis, yet no clinical recommendation about a specific pharmacologic protocol is currently available for this specific purpose. We report about the initial experience with a novel institutional bridging protocol using bivalirudin that has been developed and applied successfully in a limited number of patients.