Wessler Jeffrey D, Saldana Fidencio, Giugliano Robert P
Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Cardiovasc Revasc Med. 2012 Jan-Feb;13(1):30-8. doi: 10.1016/j.carrev.2011.08.004. Epub 2011 Oct 21.
For patients requiring surgery within their first year following coronary stent placement, maximizing the prevention of stent thrombosis with antiplatelet therapy while minimizing the risk of intraoperative bleeding has become a management challenge for cardiologists, surgeons and anesthesiologists. In this manuscript, we describe a case of a patient who received three stents (two of which were drug-eluting) and 7 months later was bridged with intravenous eptifibatide, a short-acting glycoprotein (GP) IIb/IIIa inhibitor, for 3 days prior to bronchoscopy and cervical mediastinoscopy for a suspected lung cancer. We then review the current literature for data and guidelines describing the use of short-acting GP IIb/IIIa as bridge therapy. Finally, we provide recommendations, based on our experience combined with this review, for bridge therapy in the perioperative period for patients with recent coronary stents.
对于在冠状动脉支架置入后第一年内需要手术的患者，在最大化使用抗血小板治疗预防支架血栓形成的同时，将术中出血风险降至最低，已成为心脏病专家、外科医生和麻醉医生面临的管理挑战。在本手稿中，我们描述了一例患者，该患者接受了三个支架（其中两个为药物洗脱支架），7个月后，在因疑似肺癌进行支气管镜检查和颈部纵隔镜检查前3天，使用短效糖蛋白（GP）IIb/IIIa抑制剂依替巴肽进行静脉桥接治疗。然后，我们查阅了当前文献，以获取描述使用短效GP IIb/IIIa作为桥接治疗的数据和指南。最后，基于我们的经验并结合本综述，我们为近期置入冠状动脉支架的患者围手术期桥接治疗提供建议。
