A Multidisciplinary Approach on the Perioperative Antithrombotic Management of Patients With Coronary Stents Undergoing Surgery

Rossini, Roberta; Tarantini, Giuseppe; Musumeci, Giuseppe; Masiero, Giulia; Barbato, Emanuele; Calabrò, Paolo; Capodanno, Davide; Leonardi, Sergio; Lettino, Maddalena; Limbruno, Ugo; Menozzi, Alberto; Marchese, Ugo; Saia, Francesco; Valgimigli, Marco; Ageno, Walter; Falanga, Anna; Corcione, Antonio; Locatelli, Alessandro; Montorsi, Marco; Piazza, Diego; Stella, Andréa; Bozzani, Antonio; Parolari, Alessandro; Carone, Roberto; Angiolillo, Dominick J.

doi:10.1016/j.jcin.2017.10.051

Cited by 96 publications

(67 citation statements)

References 72 publications

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“…116,117 To this end, a number of national multidisciplinary expert consensus documents have been published in an effort to standardize perioperative management of antithrombotic therapy based on balancing the predicted patient-specific ischemic risk with the anticipated procedure-specific bleeding risk. 118–120…”

Section: Proposed Hbr Definitionmentioning

confidence: 99%

Defining High Bleeding Risk in Patients Undergoing Percutaneous Coronary Intervention

et al. 2019

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Section: Proposed Hbr Definitionmentioning

confidence: 99%

Defining High Bleeding Risk in Patients Undergoing Percutaneous Coronary Intervention

et al. 2019

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“…Although clinical practice guidelines provide recommendations on perioperative management of antithrombotic therapy, they do not define the perioperative bleeding risk of different surgical procedures 116 , 117 . To this end, a number of national multidisciplinary expert consensus documents have been published in an effort to standardize perioperative management of antithrombotic therapy based on balancing the predicted patient-specific ischemic risk with the anticipated procedure-specific bleeding risk 118–120 …”

Section: Proposed Hbr Definitionmentioning

confidence: 99%

“…No data are available on bleeding rates when urgent PCI is required after recent major surgery or trauma. The bleeding risk of different types of surgery (including trauma surgery) has been reviewed recently 118 …”

Section: Proposed Hbr Definitionmentioning

confidence: 99%

Defining high bleeding risk in patients undergoing percutaneous coronary intervention: a consensus document from the Academic Research Consortium for High Bleeding Risk

Urban

Mehran

Colleran

et al. 2019

European Heart Journal

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419

287

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Identification and management of patients at high bleeding risk undergoing percutaneous coronary intervention are of major importance, but a lack of standardization in defining this population limits trial design, data interpretation, and clinical decision-making. The Academic Research Consortium for High Bleeding Risk (ARC-HBR) is a collaboration among leading research organizations, regulatory authorities, and physician-scientists from the United States, Asia, and Europe focusing on percutaneous coronary intervention–related bleeding. Two meetings of the 31-member consortium were held in Washington, DC, in April 2018 and in Paris, France, in October 2018. These meetings were organized by the Cardiovascular European Research Center on behalf of the ARC-HBR group and included representatives of the US Food and Drug Administration and the Japanese Pharmaceuticals and Medical Devices Agency, as well as observers from the pharmaceutical and medical device industries. A consensus definition of patients at high bleeding risk was developed that was based on review of the available evidence. The definition is intended to provide consistency in defining this population for clinical trials and to complement clinical decision-making and regulatory review. The proposed ARC-HBR consensus document represents the first pragmatic approach to a consistent definition of high bleeding risk in clinical trials evaluating the safety and effectiveness of devices and drug regimens for patients undergoing percutaneous coronary intervention.

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“…platelet drugs as a bridging therapy in patients with high ischemic risk undergoing nondeferrable surgery with a high risk of bleeding and therefore requiring an interruption of antiplatelet therapy. 96 The consensus document, building on the results of the BRIDGE trial, advises that cangrelor with a bridge dose regimen can be started after the suspension of the oral P2Y 12 inhibitor, and can be discontinued 1 h before the start of surgery. Subsequently, antiplatelet therapy should be resumed with oral loading of a P2Y 12 inhibitor or, if oral administration is not feasible, with cangrelor.…”

Section: Cangrelormentioning

confidence: 99%

Intravenous antiplatelet therapies (glycoprotein IIb/IIIa receptor inhibitors and cangrelor) in percutaneous coronary intervention: from pharmacology to indications for clinical use

Capodanno

Milluzzo

Angiolillo

2019

Therapeutic Advances in Cardiovascular Disease

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Oral antiplatelet drugs are crucially important for patients with acute coronary syndrome or stable coronary artery disease undergoing percutaneous coronary intervention (PCI). In recent decades, several clinical trials have focused on reducing periprocedural ischemic events in patients undergoing PCI by means of more rapid platelet inhibition with the use of intravenous antiplatelet drugs. Glycoprotein IIb/IIIa receptor inhibitors (GPIs) block the final common pathway of platelet aggregation and enable potent inhibition in the peri-PCI period. In recent years, however, the use of GPIs has decreased due to bleeding concerns and the availability of more potent oral P2Y12 inhibitors. Cangrelor is an intravenous P2Y12 receptor antagonist. In a large-scale regulatory trial, cangrelor administration during PCI allowed for rapid, potent and rapidly reversible inhibition of platelet aggregation, with an anti-ischemic benefit and no increase in major bleeding. This article aims to provide an overview of general pharmacology, supporting evidence and current status of intravenous antiplatelet therapies (GPIs and cangrelor), with a focus on contemporary indications for their clinical use.

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A Multidisciplinary Approach on the Perioperative Antithrombotic Management of Patients With Coronary Stents Undergoing Surgery

Cited by 96 publications

References 72 publications

Defining High Bleeding Risk in Patients Undergoing Percutaneous Coronary Intervention

Defining High Bleeding Risk in Patients Undergoing Percutaneous Coronary Intervention

Defining high bleeding risk in patients undergoing percutaneous coronary intervention: a consensus document from the Academic Research Consortium for High Bleeding Risk

Intravenous antiplatelet therapies (glycoprotein IIb/IIIa receptor inhibitors and cangrelor) in percutaneous coronary intervention: from pharmacology to indications for clinical use

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