Battistina Castiglioni

Fondazione Audiologica Varese

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Corrado Lettieri

Azienda Ospedaliera Carlo Poma

Roberta Rossini

Istituti di Ricovero e Cura a Carattere Scientifico

Marco Ferlini

Policlinico San Matteo Fondazione

Daniela Trabattoni

Centro Cardiologico Monzino

Emanuela Piccaluga

Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda

Alessandro Martinoni

Aziende Socio Sanitarie Territoriale Ovest Milanese

Luigi Oltrona Visconti

Policlinico San Matteo Fondazione

Federica Ettori

Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia

Stefano De Servi

University of Pavia

Giuseppe Tarantini

University of Padua

Cooperative Institutions

Istituti di Ricovero e Cura a Carattere Scientifico

University of Milan

Ospedale Maggiore

Policlinico San Matteo Fondazione

Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico

Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda

University of Pavia

General Department of Preventive Medicine

University of Padua

Azienda Ospedaliera Ospedale Civile di Legnano

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Perioperative management of antiplatelet therapy in patients with coronary stents undergoing cardiac and non-cardiac surgery: a consensus document from Italian cardiological, surgical and anaesthesiological societies

EuroIntervention (2014)

Roberta Rossini Giuseppe Musumeci Luigi Oltrona Visconti Ezio Bramucci Battistina Castiglioni

Optimal perioperative antiplatelet therapy in patients with coronary stents undergoing surgery still remains poorly defined and a matter of debate among cardiologists, surgeons and anaesthesiologists. Surgery represents one of the most common reasons for premature antiplatelet therapy discontinuation, which is associated with a significant increase in mortality and major adverse cardiac events, in particular stent thrombosis. Clinical practice guidelines provide little support with regard to managing antiplatelet therapy in the perioperative phase in the case of patients with non-deferrable surgical interventions and/or high haemorrhagic risk. Moreover, a standard definition of ischaemic and haemorrhagic risk has never been determined. Finally, recommendations shared by cardiologists, surgeons and anaesthesiologists are lacking. The present consensus document provides practical recommendations on the perioperative management of antiplatelet therapy in patients with coronary stents undergoing surgery. Cardiologists, surgeons and anaesthesiologists have contributed equally to its creation. On the basis of clinical and angiographic data, the individual thrombotic risk has been defined. All surgical interventions have been classified according to their inherent haemorrhagic risk. A consensus on the optimal antiplatelet regimen in the perioperative phase has been reached on the basis of the ischaemic and haemorrhagic risk. Aspirin should be continued perioperatively in the majority of surgical operations, whereas dual antiplatelet therapy should not be withdrawn for surgery in the case of low bleeding risk. In selected patients at high risk for both bleeding and ischaemic events, when oral antiplatelet therapy withdrawal is required, perioperative treatment with short-acting intravenous glycoprotein IIb/IIIa inhibitors (tirofiban or eptifibatide) should be taken into consideration.

Tirofiban

Eptifibatide

Discontinuation

Vascular surgery

10.4244/eijv10i1a8

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Citations (132)

CRT-100 Management and Long-term Prognosis of Spontaneous Coronary Artery Dissection: Results From A Multicentre Observational Study

КАРДИОЛОГИЯ УЗБЕКИСТАНА (2015)

Corrado Lettieri Battistina Castiglioni Dennis Zavalloni Giuseppe Musumeci Federica Ettori

Artery dissection

10.1016/j.jcin.2014.12.030

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Citations (0)

Cutaneous manifestations of pediatric HIV infection

European Journal of Pediatric Dermatology/PD. European journal of pediatric dermatology (1999)

M. Bellosta Anna Maccabruni Francesco Baldini Battistina Castiglioni

Source

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Citations (0)

Contents

The American Journal of Cardiology (2010)

Giampaolo Niccoli Cristina Spaziani Marcello Marino Maria Luisa Pontecorvo Miriam Shanks

10.1016/s0002-9149(10)00427-3

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Citations (0)

Downstream or upstream administration of P2Y12 receptor blockers in non-ST elevated acute coronary syndromes: study protocol for a randomized controlled trial

Trials (2020)

Giuseppe Tarantini Marco Mojoli Ferdinando Varbella Roberto Caporale Stefano Rigattieri

Abstract Background The optimal timing to administer a P2Y12 inhibitor in patients presenting with a non-ST elevation acute coronary syndrome remains a topic of debate. Pretreatment with ticagrelor before coronary anatomy is known as a widely adopted strategy. However, there is poor evidence on how this compares with administration of a P2Y12 inhibitor after defining coronary anatomy (i.e., downstream administration). Moreover, there are limited head-to-head comparisons of the two P2Y12 inhibitors—ticagrelor and prasugrel—currently recommended by the guidelines. Study design DUBIUS is a phase 4, multicenter, parallel-group, double randomized study conducted in NSTE-ACS patients designed to compare a pretreatment strategy (including only ticagrelor) versus a downstream strategy (including prasugrel or ticagrelor) and to compare downstream prasugrel with downstream ticagrelor. A total of 2520 patients will be randomly assigned to pretreatment with ticagrelor or to no pretreatment. The PCI group of the downstream arm will be further randomized to receive prasugrel or ticagrelor. The two primary hypotheses are that the downstream strategy is superior to the upstream strategy and that downstream ticagrelor is non-inferior to downstream prasugrel, both measured by the incidence of a composite efficacy and safety endpoint of death from vascular causes, non-fatal MI, or non-fatal stroke, and Bleeding Academic Research Consortium (BARC) type 3, 4, and 5 bleedings. Conclusions The DUBIUS study will provide important evidence related to the benefits and risks of pretreatment with ticagrelor compared with a strategy of no pretreatment. Moreover, the clinical impact of using downstream ticagrelor compared with downstream prasugrel will be assessed. Trial registration ClinicalTrials.gov NCT02618837 . Registered on 1 December 2015.

10.1186/s13063-020-04859-1

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Citations (1)

Management and Long-Term Prognosis of Spontaneous Coronary Artery Dissection

The American Journal of Cardiology (2015)

Corrado Lettieri Dennis Zavalloni Roberta Rossini Nuccia Morici Federica Ettori

TIMI

Scad

10.1016/j.amjcard.2015.03.039

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Citations (270)

Radionuclide ventriculography with dobutamine stress testing for risk stratification in post-infarction patients

Journal of Nuclear Cardiology (1995)

Edoardo Verna Luca Ceriani Claudia Carella Luca Giovanella Battistina Castiglioni

Stress testing (software)

Dobutamine

Risk Stratification

10.1016/s1071-3581(05)80183-7

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Citations (0)

Position paper SICI-GISE: Miglioramento della radioprotezione nel laboratorio di Emodinamica

Giornale italiano di cardiologia (2019)

Alessandro Sciahbasi Emanuela Piccaluga Maria Grazia Andreassi Annalisa Trianni A. Rosi

Position (finance)

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Citations (1)

Importance and limits of pre-hospital electrocardiogram in patients with ST elevation myocardial infarction undergoing percutaneous coronary angioplasty

European Journal of Cardiovascular Prevention & Rehabilitation (2011)

Alessandro Martinoni Stefano De Servi Enrico Boschetti Roberto Zanini Tullio Palmerini

The purpose of this study is to present data on the effects of pre-hospital electrocardiogram (PH-ECG) on the outcome of ST elevation myocardial infarction (STEMI) patients treated with percutaneous coronary angioplasty (PCI) included in a registry undertaken in the Italian region of Lombardy. Pre-hospital 12-lead electrocardiogram is recommended by current guidelines in order to achieve faster times to reperfusion in patients with STEMI.The registry includes 3901 STEMI patients who underwent primary PCI over an 18-month period.Mean age was 63 ± 12 years. Admission through the emergency medical system (EMS) occurred in 1603 patients (40%): they were older, more frequently had previous MI, TIMI flow = 0 at entry and were more frequently in Killip class >1 than patients who were not admitted through the EMS. Among the patients admitted through the EMS, PH-ECG was obtained in 475 patients (12%). These patients had less frequently an anterior MI, but more frequently had absence of TIMI flow at entry than patients whose ECG was not teletransmitted. Moreover, they had a significantly shorter first medical contact-to-balloon time and a trend toward a lower 30-day death rate (5.3% vs 7.9 %, p = 0.06). However, only patients in Killip class 2-3 had a significantly lower mortality when the diagnostic ECG was transmitted, whereas no difference was found in Killip class 1 or Killip class 4 patients.In this registry, PH-ECG significantly decreased first medical contact-to-balloon time. Attempts to achieve faster reperfusion times should be undertaken, as this may result in improved outcome, particularly in patients with mild to moderate symptoms of heart failure.

Killip class

TIMI

ST elevation

10.1177/1741826710389395

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Citations (33)

[Coronary stenting and surgery: perioperative management of antiplatelet therapy in patients undergoing surgery after coronary stent implantation].

PubMed (2012)

Roberta Rossini Ezio Bramucci Battistina Castiglioni Stefano De Servi Corrado Lettieri

The management of antiplatelet therapy in patients with coronary stents undergoing surgery is a growing clinical problem and often represents a matter of debate between cardiologists and surgeons. It has been estimated that about 4-8% of patients undergoing coronary stenting need to undergo surgery within the next year. Surgery represents one of the most common reasons for premature antiplatelet therapy discontinuation, which is associated with a significant increase in mortality and major adverse cardiac events, in particular stent thrombosis. In addition, surgery confers an additional risk of perioperative cardiac ischemic events, being high in these patients because of the pro-inflammatory and pro-thrombotic effects of surgery. Current international guidelines recommend to postpone non-urgent surgery for at least 6 weeks after bare metal stent implantation and for 6-12 months after drug-eluting stent implantation. However, these recommendations provide little support with regard to managing antiplatelet therapy in the perioperative phase in case of urgent operations and/or high hemorrhagic risk. Furthermore, ischemic and hemorrhagic risk is not defined in detail on the basis of clinical and procedural characteristics. Finally, guidelines shared with cardiologists and surgeons are lacking. The present consensus document provides practical recommendations on the management of antiplatelet therapy in the perioperative period in patients with coronary stents undergoing surgery. Cardiologists and surgeons contributed equally to its creation. An ischemic risk stratification has been provided on the basis of clinical and procedural data. All surgical interventions have been defined on the basis of the hemorrhagic risk. A consensus on the most appropriate antiplatelet regimen in the perioperative phase has been reached on the basis of the ischemic and hemorrhagic risk. Dual antiplatelet therapy should not be withdrawn for surgery at low bleeding risk, whereas aspirin should be continued perioperatively in the majority of surgical operations. In the event of interventions at high risk for both bleeding and ischemic events, when oral antiplatelet therapy withdrawal is required, perioperative treatment with short-acting intravenous glycoprotein IIb/IIIa inhibitors (tirofiban or eptifibatide) should be considered.

Discontinuation

Coronary stent

Bare-metal stent

Interventional cardiology

10.1714/1114.12251

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Citations (16)