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Valenti R, Muraca I, Marcucci R, Ciatti F, Berteotti M, Gori AM, Carrabba N, Migliorini A, Marchionni N, Valgimigli M. "Tailored" antiplatelet bridging therapy with cangrelor: moving toward personalized medicine. Platelets 2021; 33:687-691. [PMID: 34672898 DOI: 10.1080/09537104.2021.1983162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In the setting of patients with indication to receive dual antiplatelet therapy undergoing surgery or invasive procedures, the risk of perioperative cardiac ischemic events, particularly stent thrombosis, is high, because surgery has a prothrombotic effect and antiplatelet therapy is withdrawn in order to avoid bleeding complications. Cangrelor, an intravenous P2Y12 receptor antagonist, has been tested in a randomized trial as a "bridge" to cardiac surgery from discontinuation of oral P2Y12 receptor antagonists. Thus, a consensus document extended its off-label use in this setting and before non-cardiac surgery. Currently, despite the implementation of a standardized bridging protocol with cangrelor, a residual risk of adverse outcome mainly due to bleeding events, still persist during the perioperative phase.Accordingly, a personalized management driven by platelet reactivity serial measurements and careful assessment of ischemic and bleeding risks has potential to optimize outcomes and costs as compared to a standardized bridging protocol, based on average pharmacodynamic data of oral P2Y12 inhibitors.While specific indications for bridging have been extensively addressed in the aforementioned consensus statement, the aim of the present document is the proposal of a "tailored" clinical decision-making algorithm inspired to the principle of personalized medicine dealing with complex clinical scenarios.
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Affiliation(s)
- Renato Valenti
- From the Interventional Cardiology Unit, Cardiovascular Department, Careggi University Hospital, Florence, Italy
| | - Iacopo Muraca
- From the Interventional Cardiology Unit, Cardiovascular Department, Careggi University Hospital, Florence, Italy
| | - Rossella Marcucci
- From the Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Francesca Ciatti
- From the Interventional Cardiology Unit, Cardiovascular Department, Careggi University Hospital, Florence, Italy
| | - Martina Berteotti
- From the Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Anna Maria Gori
- From the Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Nazario Carrabba
- From the Interventional Cardiology Unit, Cardiovascular Department, Careggi University Hospital, Florence, Italy
| | - Angela Migliorini
- From the Interventional Cardiology Unit, Cardiovascular Department, Careggi University Hospital, Florence, Italy
| | - Niccolò Marchionni
- From the Interventional Cardiology Unit, Cardiovascular Department, Careggi University Hospital, Florence, Italy
| | - Marco Valgimigli
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (Eoc), Lugano, Switzerland; Department of Cardiology, University of Bern, Bern, Switzerland
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