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Review
. 2021 Dec 1:20:e20210113.
doi: 10.1590/1677-5449.210113. eCollection 2021.

Efficacy and safety of tirofiban bridge as an alternative to suspension of dual antiplatelet therapy in patients undergoing surgery: a systematic review

Lorrane Vieira Siqueira Riscado  1 , João Henrique Sendrete de Pinho  1 , Armando de Carvalho Lobato  2
Affiliations
Review

Efficacy and safety of tirofiban bridge as an alternative to suspension of dual antiplatelet therapy in patients undergoing surgery: a systematic review

Lorrane Vieira Siqueira Riscado et al. J Vasc Bras. .

Abstract
in English, Portuguese

Use of a tirofiban bridge is an alternative to simply withdrawing dual antiplatelet therapy prior to operating on patients at high risk of stent thrombosis and bleeding. We aimed to evaluate the efficacy and safety of this protocol in patients undergoing surgery within 12 months of a percutaneous coronary intervention involving stenting. We performed a systematic review based on searches of the PubMed, Web of Science, Cochrane, Embase, Lilacs, and Scielo databases and of the references of relevant articles on the topic. Five of the 107 studies identified were included after application of eligibility criteria and analysis of methodological quality, totaling 422 patients, 227 in control groups. Notwithstanding the limitations reported, four of the five studies included indicate that the tirofiban bridge technique is effective for reducing adverse cardiac events and is safe in terms of not interfering with the risk of hemorrhagic events or bleeding. However, randomized clinical trials are needed to provide robust evidence.

Resumo: A ponte de tirofiban é uma alternativa à suspensão da terapia antiplaquetária dupla no perioperatório de pacientes com alto risco de trombose de stent e de sangramento. Objetivamos avaliar a eficácia e a segurança deste protocolo em pacientes submetidos à cirurgia em até 12 meses após intervenção coronária percutânea com stent. Realizamos uma revisão sistemática por meio de pesquisa nas bases PubMed, Web of Science, Cochrane, EMBASE, LILACS e SciELO e nas referências de artigos relevantes ao tema. Dos 107 trabalhos encontrados, cinco foram incluídos após análise dos critérios de elegibilidade e da qualidade metodológica, totalizando 422 pacientes, sendo 227 do grupo controle. Apesar das limitações reportadas, quatro dos cinco estudos incluídos indicam que a ponte de tirofiban é eficaz em reduzir eventos cardíacos adversos e segura ao não interferir no risco de eventos hemorrágicos ou sangramentos. Todavia, são necessários ensaios clínicos randomizados para evidências robustas.

Keywords: bridge; surgery; tirofiban.

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Conflict of interest statement

Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

Figures

Figure 1
Figure 1. Flow diagram illustrating identification, screening, eligibility, and inclusion of studies in the systematic review. n = number of articles.
Figura 1
Figura 1. Fluxograma de identificação, triagem, elegibilidade e inclusão de estudos na revisão sistemática. n = número de artigos.
See this image and copyright information in PMC

References

    1. Mauri L, Kereiakes DJ, Yeh RW, et al. Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents. N Engl J Med. 2014;371(23):2155–2166. doi: 10.1056/NEJMoa1409312. - DOI - PMC - PubMed
    1. Baigent C, Sudlow C, Collins R, Peto R. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002;324(7329):71–86. doi: 10.1136/bmj.324.7329.71. - DOI - PMC - PubMed
    1. De Luca L, Bellettini E, Di Maio D, et al. Oral antiplatelet therapy for secondary prevention of non-cardioembolic ischemic cerebrovascular events. J Clin Med. 2021;10(8):1721. doi: 10.3390/jcm10081721. - DOI - PMC - PubMed
    1. Levine GN, Bates ER, Bittl JA, et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2016;134(10):e123–55. doi: 10.1161/CIR.0000000000000404. - DOI - PubMed
    1. Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American college of cardiology/American heart association task force on practice guidelines. J Am Coll Cardiol. 2014;64(22):e77–137. doi: 10.1016/j.jacc.2014.07.944. - DOI - PubMed

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