Roberta Rossini et al. JCIN 2018;11:

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Roberta Rossini et al. JCIN 2018;11:417-434 Bridging Protocol Using Cangrelor for Patients on Dual Antiplatelet Therapy With Aspirin Plus a P2Y12 Receptor Inhibitor Referred to Cardiac or Noncardiac Surgery Clopidogrel and ticagrelor should be discontinued for 5 days and prasugrel for 7 days. Start cangrelor at bridging dose regimen 3 to 4 days after prasugrel discontinuation and 2 to 3 days of clopidogrel and ticagrelor discontinuation and discontinue 1 to 6 h before surgery. Platelet function testing may be considered to help guide timing of starting cangrelor infusion. After surgery, prasugrel and ticagrelor administration should be discouraged and clopidogrel should be resumed with a loading dose as soon as oral administration is possible and the risk of severe bleeding is acceptable. If the use of oral P2Y12 inhibiting therapy is not possible, post-surgery bridging might be considered. Roberta Rossini et al. JCIN 2018;11:417-434 2018 American College of Cardiology Foundation