In:
Clinical Cardiology, Wiley, Vol. 38, No. 2 ( 2015-02), p. 92-98
Abstract:
Guidelines recommend delaying coronary artery bypass grafting ( CABG ) for 5 days after discontinuing clopidogrel. However, platelet function may recover quicker in certain individuals. Hypothesis We hypothesized that perioperative measurement of platelet function with a point‐of‐care P2Y 12 inhibitor assay could predict bleeding during CABG in patients exposed to clopidogrel. Methods Verify Pre‐Op TIMI 45 was a prospective pilot study of 39 patients on clopidogrel who subsequently underwent CABG . Preoperative on‐treatment platelet reactivity was assessed with VerifyNow P2Y 12 Reaction Units ( PRU ), with higher PRU indicating more reactive platelets. Outcomes were stratified by PRU quartiles, as well as prespecified cutpoints for the lowest quartile ( PRU 173), a cutpoint for major bleeding determined by the Youden index using receiver operator curve analysis ( PRU 207), and clopidogrel resistance ( PRU 230). Results Patients in higher PRU quartiles experienced smaller decreases in hemoglobin and hematocrit ( P 〈 0.05 for all comparisons), less major bleeding ( P = 0.021), and less major or minor bleeding ( P = 0.003). Patients above the PRU 207 and 230 cutpoints had less chest‐tube output ( P = 0.041 and P = 0.012, respectively), less major bleeding ( P = 0.005 and P = 0.036, respectively), and less major or minor bleeding ( P = 0.013 and P 〈 0.001, respectively). By receiver operator curve analysis, preoperative PRU ≤ 207 discriminated between patients with and without major bleeding during surgery (area under the curve: 0.76, 95% confidence interval: 0.59‐0.94, P = 0.018). Conclusions In this pilot study, we found that point‐of‐care platelet function assessment could predict bleeding in patients recently exposed to clopidogrel undergoing CABG .
Type of Medium:
Online Resource
ISSN:
0160-9289
,
1932-8737
Language:
English
Publisher:
Wiley
Publication Date:
2015
detail.hit.zdb_id:
2048223-1
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