Current strategies for bridging dual antiplatelet therapy in patients requiring surgery

2015 Managing patients on dual antiplatelet therapy (APT) requiring surgery constitutes a challenging task in clinical practice, necessitating cooperation between cardiologists and surgeons. Balancing hemorrhagic and ischemic risk dictates perioperative handling of oral APT, a task often difficult to accomplish. Recruitment of APT-bridging strategies can be mandatory in patients at very high thrombotic and bleeding risk, although robust evidence from randomized trials is lacking. Of the commercially available agents, glycoprotein IIb/IIIa inhibitors might be regarded as the most appropriate for bridging purposes and cangrelor, which is not available yet, could be an attractive first choice option.