Adrenal suppression with mometasone furoate/formoterol.

journal.publications.chestnet.org The rationale for perioperative bridging is anchored on mitigating the risk of major cardiovascular events, including stent thrombosis, in patients who require surgery and in whom the associated risk of bridging-related bleeding is acceptably low. A number of agents, including unfractionated heparin, low-molecular-weight heparins, glycoprotein IIb/IIIa antagonists, direct thrombin inhibitors (bivalirudin), and reversible platelet P2Y 12 -receptor inhibitors, have been proposed and studied as bridging agents. We recognize the foundational work at The Geelong Hospital and that carried out by Savonitto et al 3 and Bolsin et al. 4 These case reports and observational studies provide the impetus and rationale for future study in this area. Further encouraging evidence comes from a recent randomized, placebo-controlled trial of 210 patients with acute coronary syndromes or treated with a coronary stent on a thienopyridine, awaiting coronary artery bypass grafting. In this study, patients received IV cangrelor, a short-acting, reversible P2Y 12 -receptor inhibitor, or placebo for at least 48 h, which was stopped 1 to 6 h before surgery. Patients in the cangrelor group had lower levels of platelet reactivity with no signifi cant increase in coronary artery bypass grafting-related bleeding. 5