Table 4 Evidence Table for Bridging Studies
Author, year Study design Setting | Sample size Average age % Female | Operations included | Stent types included and average time since implantation | Antiplatelet strategy | 30-day MACE rate | Bleeding Rate | |||
|---|---|---|---|---|---|---|---|---|---|
Preoperative | Perioperative | Bridge | Postoperative | ||||||
Alshawabkeh, 2013 [19] Retrospective Single center Academic USA | 51 65 years old 0% | Abdominal Endoscopy Neuro Orthopedic Vascular Other | DES 13.9 months ± 1.7 | Dual (C/A) (51/51) | Held all (18/51) Held clopidogrel (33/51) | Admit day after clopidogrel discontinued, IIb/IIIa drip initiated | Clopidogrel resumed at discretion of surgeon (mean 1.2 days) | 7.8% (4/51)1 | 7.8% (4/51)1,2 |
Capodanno, 2015 [22] Retrospective Multi-center Academic Italy | 515 68 years old 21% | Abdominal Endoscopy Neuro Ophthalmology Orthopedic Vascular Other | BMS, DES 30% < 180 days | Dual (C/A) (162/515) Single (ASA) (353/515) | Continued dual (108/515) Continued ASA (158/515) Held all (251/515) -->LMWH | Clopidogrel held at least 5 days, ASA held at least 2 days prior to procedure; LMWH bridge | LMWH continued until APT resumed (timing not specified) | LMWH: 7.8% (14/179) No LMWH: 0.6% (1/179) | LMWH: 22.3% (40/179) No LMWH: 13.4% (24/179)3 |
Conroy, 2007 [20] Retrospective Single center Academic Australia | 22 pts., 42 procedures Not specified | Abdominal Endoscopy Other | DES Not specified | Dual (C/A) (39/42) | Continued dual (21/39) Held clopidogrel (18/39) | LMWH bridge (2/18) IIb/IIIa bridge (2/18) No bridge (14/18) | Not specified | Dual: 0% (0/21) Dual held, +bridge: 0% (0/4) Dual held, −bridge: 21% (3/14)1 | Dual: 4.8% (1/21) Dual, held, ±bridge: 0% (0/18)1,4 |
Marcos, 2011 [21] Retrospective Single center Academic Netherlands | 36, 21 non-cardiac For entire sample: 66 years old 31% | Abdominal Endoscopy Orthopedic Other | DES For entire sample: 80 days ± 66 | Dual (C/A) (36/36) | Held all (7/36) Held clopidogrel (29/36) | Discontinued clopidogrel 5 days preop, admit 3 days prior, tirofiban drip Discontinued clopidogrel 5 days preop, admit 2 days prior, tirofiban drip | If no risk of bleeding, clopidogrel restarted 12-24 h postop If high-risk, heparin drip until risk was lower | 0% | 19% (4/21)5 |
Sonobe, 2011 [23] Retrospective Single center Academic Japan | 38 71 years old 13% | Other: Major Thoracic | BMS, DES 31 months | Dual (ASA + P2Y12) (16/38) Single (ASA) (21/38) None (1/38) Coumadin (9/38) | Held all (38/38) | (+) Heparin drip (16/38) (−) Heparin drip (22/38) | At discretion of surgeon (median 4 days) | (+) Heparin: 0% (0/16) (−) Heparin: 0% (0/22) | (+) Heparin: 0% (0/16) (−) Heparin: 0% (0/22) |
Tanaka, 2016 [24] Retrospective Single center Academic Japan | 210 71 years old 15.7% | Abdominal Endoscopy Ophthalmology Orthopedic Vascular Other | DES 31.9 months ± 23 | Dual (ASA + P2Y12) (129/210) Single (ASA) (60/210) Single (P2Y12) (19/210) Coumadin (20/210) | Held all (210/210) | Heparin drip | Restarted heparin drip 2–6 h (low risk) or 10–12 h (high risk) after surgery; APT restarted mean 4.5 days after surgery | 0% (0/210) | 7.6% (16/210)6 |