Bridging Antiplatelet Therapy After Percutaneous Coronary Intervention: JACC Review Topic of the Week

Alexander E. Sullivan, Michael G. Nanna, Tracy Y. Wang, Deepak L. Bhatt, Dominick J. Angiolillo, Roxana Mehran, Subhash Banerjee, Sarah Cantrell, W. Schuyler Jones, Jennifer A. Rymer, Jeffrey B. Washam, Sunil V. Rao, E. Magnus Ohman

Research output: Contribution to journalReview articlepeer-review

9 Scopus citations


Patients undergoing early surgery after coronary stent implantation are at increased risk for mortality from ischemic and hemorrhagic complications. The optimal antiplatelet strategy in patients who cannot discontinue dual antiplatelet therapy (DAPT) before surgery is unclear. Current guidelines, based on surgical and clinical characteristics, provide risk stratification for bridging therapy with intravenous antiplatelet agents, but management is guided primarily by expert opinion. This review summarizes perioperative risk factors to consider before discontinuing DAPT and reviews the data for intravenous bridging therapies. Published reports have included bridging options such as small molecule glycoprotein IIb/IIIa inhibitors (eptifibatide or tirofiban) and cangrelor, an intravenous P2Y12 inhibitor. However, optimal management of these complex patients remains unclear in the absence of randomized controlled data, without which an argument can be made both for and against the use of perioperative intravenous bridging therapy after discontinuing oral P2Y12 inhibitors. Multidisciplinary risk assessment remains a critical component of perioperative care.

Original languageEnglish (US)
Pages (from-to)1550-1563
Number of pages14
JournalJournal of the American College of Cardiology
Issue number15
StatePublished - Oct 12 2021


  • antiplatelet therapy
  • bleeding
  • cangrelor
  • stent
  • surgery
  • thrombosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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