TY - JOUR
T1 - Does Platelet Reactivity Predict Bleeding in Patients Needing Urgent Coronary Artery Bypass Grafting During Dual Antiplatelet Therapy?
AU - Mahla, Elisabeth
AU - Prueller, Florian
AU - Farzi, Sylvia
AU - Pregartner, Gudrun
AU - Raggam, Reinhard B.
AU - Beran, Elisabeth
AU - Toller, Wolfgang
AU - Berghold, Andrea
AU - Tantry, Udaya S.
AU - Gurbel, Paul A.
N1 - Funding Information:
Dr Mahla received grants from CSL Behring and Novo Nordisk; Dr Gurbel from the National Institutes of Health, Daiichi Sankyo, Harvard Research Institute, New Haven Pharmaceuticals, Merck, Coramed, Haemonetics, and the Duke Clinical Research Institute. Dr Gurbel holds patents in the area of personalized antiplatelet therapy and interventional cardiology. The authors would like to acknowledge Simone Tischler, Tobias Niedrist, and Raphael Neururer for their technical assistance.
Publisher Copyright:
© 2016 The Society of Thoracic Surgeons
PY - 2016/12/1
Y1 - 2016/12/1
N2 - Background Up to 15% of patients require coronary artery bypass grafting (CABG) during dual antiplatelet therapy. Available evidence suggests an association between platelet reactivity and CABG-related bleeding. However, platelet reactivity cutoffs for bleeding remain elusive. We sought to explore the association between platelet reactivity and bleeding. Methods Patients on aspirin and a P2Y12 receptor inhibitor within 48 hours before isolated CABG (n = 149) were enrolled in this prospective study. Blood was drawn 2 to 4 hours preoperatively and platelet reactivity assessed by light transmittance aggregometry (LTA), vasodilator-stimulated phosphoprotein (VASP) assay, Multiplate analyzer and Innovance PFA2Y. The primary endpoint was calculated red blood cell loss computed as follows: (blood volume × preoperative hematocrit × 0.91) – (blood volume × hematocrit × 0.91 on postoperative day 5) + (mL of transfused red blood cells × 0.59). Results Preoperative platelet reactivity was low [median (interquartile range): LTA: 20 (9–28)%; VASP-PRI: 39 (15–73)%; Multiplate adenosine phosphate test: 16 (12–22) U∗min]. Innovance PFA2Y ≥300 seconds, 72%. Median (IQR) red blood cell loss in patients in first the LTA tertile was 1,449 (1,020 to 1,754) mL compared with 1,107 (858 to 1,512) mL and 1,075 (811 to 1,269) mL in those in the second and third tertiles, respectively (p < 0.004). Bleeding Academic Research Consortium (BARC)-4 bleeding differed between tertiles (62% versus 46% versus 36%; p = 0.037). In a multivariable linear regression model, aspirin dose ≥300 mg, cardiopulmonary bypass time, EuroSCORE, and tertile distribution of platelet reactivity were significantly associated with red blood cell loss. Conclusions A gradual decrease in red blood cell loss and BARC-4 bleeding occurs with increasing platelet reactivity in patients on antiplatelet therapy undergoing CABG. Our findings support current guidelines to determine time of surgery based on an objective measurement of platelet function (Platelet Inhibition and Bleeding in Patients Undergoing Emergent Cardiac Surgery; clinicaltrials.gov NCT01468597).
AB - Background Up to 15% of patients require coronary artery bypass grafting (CABG) during dual antiplatelet therapy. Available evidence suggests an association between platelet reactivity and CABG-related bleeding. However, platelet reactivity cutoffs for bleeding remain elusive. We sought to explore the association between platelet reactivity and bleeding. Methods Patients on aspirin and a P2Y12 receptor inhibitor within 48 hours before isolated CABG (n = 149) were enrolled in this prospective study. Blood was drawn 2 to 4 hours preoperatively and platelet reactivity assessed by light transmittance aggregometry (LTA), vasodilator-stimulated phosphoprotein (VASP) assay, Multiplate analyzer and Innovance PFA2Y. The primary endpoint was calculated red blood cell loss computed as follows: (blood volume × preoperative hematocrit × 0.91) – (blood volume × hematocrit × 0.91 on postoperative day 5) + (mL of transfused red blood cells × 0.59). Results Preoperative platelet reactivity was low [median (interquartile range): LTA: 20 (9–28)%; VASP-PRI: 39 (15–73)%; Multiplate adenosine phosphate test: 16 (12–22) U∗min]. Innovance PFA2Y ≥300 seconds, 72%. Median (IQR) red blood cell loss in patients in first the LTA tertile was 1,449 (1,020 to 1,754) mL compared with 1,107 (858 to 1,512) mL and 1,075 (811 to 1,269) mL in those in the second and third tertiles, respectively (p < 0.004). Bleeding Academic Research Consortium (BARC)-4 bleeding differed between tertiles (62% versus 46% versus 36%; p = 0.037). In a multivariable linear regression model, aspirin dose ≥300 mg, cardiopulmonary bypass time, EuroSCORE, and tertile distribution of platelet reactivity were significantly associated with red blood cell loss. Conclusions A gradual decrease in red blood cell loss and BARC-4 bleeding occurs with increasing platelet reactivity in patients on antiplatelet therapy undergoing CABG. Our findings support current guidelines to determine time of surgery based on an objective measurement of platelet function (Platelet Inhibition and Bleeding in Patients Undergoing Emergent Cardiac Surgery; clinicaltrials.gov NCT01468597).
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U2 - 10.1016/j.athoracsur.2016.05.003
DO - 10.1016/j.athoracsur.2016.05.003
M3 - Article
C2 - 27378554
AN - SCOPUS:84995912095
SN - 0003-4975
VL - 102
SP - 2010
EP - 2017
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 6
ER -