Outcomes of preoperative bridging therapy for patients undergoing surgery after coronary stent implantation: a weighted meta-analysis of 280 patients from eight studies.

Warshauer, Jeremy; Patel, Vishal G; Christopoulos, Georgios; Kotsia, Anna P; Banerjee, Subhash; Brilakis, Emmanouil S

BACKGROUND Preoperative bridging with a glycoprotein IIb/IIIa inhibitor is often performed in patients with prior coronary stents undergoing surgery who require antiplatelet therapy discontinuation, but its safety and efficacy have received limited study. We performed a weighted meta-analysis of the outcomes in patients with coronary stents undergoing bridging with glycoprotein IIb/IIIa inhibitors prior to surgery. METHODS We conducted a weighted meta-analysis of preoperative bridging studies published between 2002 and 2013 in patients with coronary stents undergoing surgery. Data on in-hospital mortality, stent thrombosis, bleeding, hemoglobin decrease, blood transfusion, time to hospital discharge and myocardial infarction were collected. RESULTS A total of eight studies with 280 patients were included. Pooled estimates of outcomes were as follows: in-hospital mortality 3.5% (95% confidence interval [CI] 1.7-5.9%); stent thrombosis 1.3% (95% CI 0.3-3.0%); major bleeding 7.4% (95% CI 2.8-14.1%); any bleeding 20.6% (95% CI 4.8-43.2%); mean decrease in hemoglobin 2.8 g/dL (95% CI 2.5-3.0 g/dL); mean blood loss 271 mL (95% CI 211-311 mL); blood transfusion 13.9% (95% CI 1.0-38.2%); time to hospital discharge 5.9 days (95% CI 4.4-7.3 days); and myocardial infarction 1.6% (95% CI 0.3-3.6%). CONCLUSIONS Preoperative bridging with a glycoprotein IIb/IIIa inhibitor in patients undergoing surgery after coronary stenting does not abolish the risk of perioperative stent thrombosis and may carry increased risk for bleeding. © 2014 Wiley Periodicals, Inc.