In patients on dual antiplatelet therapy requiring surgery, glycoprotein IIb/IIIa inhibitors or cangrelor may be appropriate bridging strategies to balance ischemic and bleeding risks.
Supports GP IIb/IIIa inhibitors or cangrelor for bridging in high-risk DAPT patients needing surgery; leaves open need for RCTs before practice change.
Managing patients on dual antiplatelet therapy (APT) requiring surgery constitutes a challenging task in clinical practice, necessitating cooperation between cardiologists and surgeons. Balancing hemorrhagic and ischemic risk dictates perioperative handling of oral APT, a task often difficult to accomplish. Recruitment of APT-bridging strategies can be mandatory in patients at very high thrombotic and bleeding risk, although robust evidence from randomized trials is lacking. Of the commercially available agents, glycoprotein IIb/IIIa inhibitors might be regarded as the most appropriate for bridging purposes and cangrelor, which is not available yet, could be an attractive first choice option.
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Anastasiou et al. (2015) studied this question.
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