Bridging antiplatelet therapy in patients requiring cardiac and non-cardiac surgery: from bench to bedside.

Dual antiplatelet therapy (DAPT) is the mainstay of pharmacotherapy after an acute coronary syndrome or percutaneous coronary intervention. While patients requiring interruption of DAPT at the time of cardiac or noncardiac surgery face an increased risk of thrombotic complications, the opportunity of continuing DAPT in the perioperative period should be balanced against the risk of bleeding. Tailoring antiplatelet therapy on patient- and surgery-specific characteristics mandates a clear understanding of pharmacodynamic and clinical data on using antithrombotic agents in the perioperative period. This is also important given the introduction of novel antiplatelet agents that are already adopted in practice (prasugrel, ticagrelor) or will likely be adopted in the near future (cangrelor). This article explores the theoretical background and rationale for bridging patients on antiplatelet drugs to their surgical procedure, and provides insights on how patient and procedural characteristics translate into different considerations for the use of antithrombotic agents in the surgical setting.