This case highlights that bridging with glycoprotein IIb/IIIa inhibitors may not fully protect against stent thrombosis in patients with DES undergoing early non-cardiac surgery.
Stent thrombosis despite GP IIb/IIIa bridging before neurosurgery warrants caution in DES patients; leaves open optimal perioperative antithrombotic strategies.
The management of patients with drug eluting stents (DES) who require early surgical intervention prior to the completion of antiplatelet therapy is challenging. Available literature suggests that bridging these high risk patients with glycoprotein IIb/IIIa (g2b3a) inhibitors could be efficacious in preventing stent thrombosis (Ben Morrison et al., Catheter Cardiovasc Interv 2012;79;575-582). However, this still remains to be proven in larger prospective studies. We report a case of stent thrombosis in a patient with DES planned for neurosurgery while on bridging g2b3a inhibitors therapy in the perioperative period.
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Singh et al. (2013) studied this question.
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