Aspirin withdrawal 5 days before major vascular surgery allowed functional platelet recovery and restored efficacy upon reintroduction, whereas clopidogrel reintroduction resulted in inadequate platelet inhibition with significantly increased platelet-leukocyte complexes (+10%; p=0.02).
Observational (n=45)
No
Does the perioperative interruption of aspirin and clopidogrel allow for functional platelet recovery and subsequent restoration of antiplatelet efficacy in patients undergoing major vascular surgery?
Aspirin withdrawal 5 days before major vascular surgery allows for predictable platelet recovery and restoration of efficacy upon reintroduction, whereas clopidogrel shows variable recovery and reduced efficacy upon reintroduction.
p-value: p=0.02
AIMS: To investigate functional platelet recovery after preoperative withdrawal of aspirin and clopidogrel and platelet function 5 days after treatment resumption. METHODS/RESULTS: We conducted an observational study, which prospectively included consecutive patients taking aspirin, taking clopidogrel, and untreated controls (15 patients in each group). The antiplatelet drugs were withdrawn five days before surgery (baseline) and were reintroduced two days after surgery. Platelet function was evaluated by optical aggregation in the presence of collagen, arachidonic acid (aspirin) and ADP (clopidogrel) and by VASP assay (clopidogrel). Platelet-leukocyte complex (PLC) level was quantified at each time-point. At baseline, platelet function was efficiently inhibited by aspirin and had recovered fully in most patients 5 days after drug withdrawal. PLC levels five days after aspirin reintroduction were similar to baseline (+4±10%; p = 0.16), in line with an effective platelet inhibition. Chronic clopidogrel treatment was associated with variable platelet inhibition and its withdrawal led to variable functional recovery. PLC levels were significantly increased five days after clopidogrel reintroduction (+10±15%; p = 0.02), compared to baseline. CONCLUSIONS: Aspirin withdrawal 5 days before high-bleeding-risk procedures was associated with functional platelet recovery, and its reintroduction two days after surgery restored antiplaletet efficacy five days later. This was not the case of clopidogrel, and further work is therefore needed to define its optimal perioperative management.
Manach et al. (Wed,) conducted a observational in Major vascular surgery (infra-renal aortic reconstructive surgery) (n=45). Preoperative withdrawal and postoperative reintroduction of aspirin or clopidogrel vs. Untreated controls and baseline values was evaluated on Change in platelet-leukocyte complex (PLC) levels 5 days after clopidogrel reintroduction compared to baseline (p=0.02). Aspirin withdrawal 5 days before major vascular surgery allowed functional platelet recovery and restored efficacy upon reintroduction, whereas clopidogrel reintroduction resulted in inadequate platelet inhibition with significantly increased platelet-leukocyte complexes (+10%; p=0.02).