Key result
Preoperative platelet inhibitory response to P2Y12 antagonists was not associated with MACEs or major bleeding after OPCAB in ACS patients.
Why the study?
Ischemic and hemorrhagic complications are major determinants of survival in ACS patients undergoing coronary surgery, prompting investigation into the role of preoperative platelet reactivity to P2Y12 antagonists.
Does preoperative platelet reactivity to P2Y12 antagonists predict perioperative major bleeding and MACEs in ACS patients undergoing OPCAB after recent DAPT?
Observational (n=177)
Does preoperative platelet reactivity to P2Y12 antagonists predict perioperative major bleeding and MACEs in ACS patients undergoing OPCAB after recent DAPT?
In ACS patients receiving DAPT within 5 days of OPCAB, preoperative platelet inhibitory response to P2Y12 antagonists was not associated with perioperative ischemic or hemorrhagic complications, suggesting routine platelet function testing may be unnecessary in this setting.
Answers are grounded in this paper and cite their sources.
No association seen with MACE or bleeding; leaves open whether routine platelet testing adds value in ACS patients undergoing OPCAB.
Ischemic and hemorrhagic complications are major determinants of survival in acute coronary syndrome (ACS) patients undergoing coronary surgery. We investigated the association of preoperative platelet reactivity to P2Y12 antagonists with ischemic and hemorrhagic complications after Off-Pump Coronary Artery Bypass surgery (OPCAB) in ACS patients who received dual anti-platelet therapy (DAPT) within 5 days prior to surgery. This prospective, observational study with 177 patients compared the incidence of perioperative major bleeding and major adverse cardiac events (MACEs) in relation to the tertile distribution of the % inhibitory response to P2Y12 antagonists, as measured by a thromboelastography platelet mapping assay. The incidences of perioperative major bleeding and MACEs were similar in relation to the tertile distribution of inhibitory response to P2Y12 antagonists. The % inhibitory responses to P2Y12 antagonists between patients who did or did not exhibit MACEs, and with or without major bleeding, were 58 ± 20% and 56 ± 20% (p = 0.578) and 57 ± 19% and 56 ± 21% (p = 0.923), respectively. In ACS patients who received DAPT close to OPCAB, the platelet inhibitory response to P2Y12 antagonists was not associated with ischemic or hemorrhagic complications. OPCAB may obviate the need for routine platelet function testing for ACS patients requiring DAPT and surgical revascularization. Clinical Registration Number: NCT02184884.
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Soh et al. (2022) conducted an observational in Acute Coronary Syndrome (ACS) (n=177). Preoperative platelet reactivity to P2Y12 antagonists vs. Tertile distribution of inhibitory response was evaluated on Perioperative major bleeding and major adverse cardiac events (MACEs) (p=0.578 and 0.923). Preoperative platelet inhibitory response to P2Y12 antagonists was not associated with MACEs or major bleeding after OPCAB in ACS patients.
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