Abstract 12558: Does Platelet Inhibition Predict Surgery Related Bleeding in Patients Undergoing Emergent Cardiac Surgery During Dual Antiplatelet Therapy?
Introduction: Three to 15 % of patients with ACS require CABG during dual antiplatelet therapy. Available evidence suggests an association between platelet reactivity levels and CABG-related bleeding. However, platelet reactivity cutoffs for bleeding remain elusive. The current study aimed to explore the association between platelet reactivity and CABG-related bleeding, defined as calculated perioperative red blood cell (RBC) loss.
Methods: A total of 161 patients (69±9 yrs; EUROscore: 8.9±4.5) on aspirin and a P2Y12 receptor inhibitor within 48 hours before CABG (clopidogrel: n=86; prasugrel: n=29, ticagrelor: n=46) were included. Blood was drawn preoperatively and platelet reactivity to ADP (5μM) was determined by light transmission aggregometry. Perioperative RBC loss was calculated as follows: (blood volume*preoperative HTC*0.91) - (Blood volume*HTC on postoperative day 5) + (milliliters of transfused red blood cells*0.59).
Results: Maximum platelet aggregation [median (IQR)] was higher in patients on clopidogrel [25.5% (19.9%)] as compared to patients on prasugrel [12.5% (12%)] or ticagrelor [10.8% (17.1%); p<0.001]. There was a weak correlation between aggregation and RBC loss (r=-0.16; p=0.05). RBC loss was higher in patients on prasugrel or ticagrelor as compared to patients on clopidogrel (figure). Bleeding Academic Research Consortium (BARC) bleeding occurred in 43% of patients on clopidogrel as compared to 69% and 59% of prasugrel and ticagrelor treated patients, respectively (overall: p=0.031; p=0.016 between clopidogrel and prasugrel).
Conclusions: Despite an only weak correlation between platelet reactivity and CABG-related bleeding, this study demonstrates for the first time a higher perioperative RBC loss in patients undergoing CABG within 48 hours of last administration of prasugrel or ticagrelor as compared to clopidogrel.
Author Disclosures: E. Mahla: Honoraria; Modest; Speaker’s fee from Astra-Zeneca. F. Prueller: None. S. Farzi: None. A. Berghold: None. R. Raggam: None. E. Beran: None. W. Toller: None. U.S. Tantry: None. P.A. Gurbel: Research Grant; Significant; NIH, Daiichi Sankyo, Lilly, CSL, Astra-Zeneca, Harvard Clinical Research Institute, Haemonetics, Duke Clinical Research Institute. Speakers Bureau; Significant; Lilly, Daiichi Sankyo, Astra-Zeneca, Merck. Ownership Interest; Significant; Stock options Merck, Medtronic, Pfizer. Consultant/Advisory Board; Significant; Daiichi Sankyo/Lilly, Bayer, Astra-Zeneca, Boehringer, Merck, CSL, Haemonetics. Other; Significant; Patent (personalized antiplatelet therapy and interventional cardiology).
- © 2014 by American Heart Association, Inc.