What question did this study set out to answer?

To determine whether tailoring the timing of coronary artery bypass graft surgery using platelet function testing reduces bleeding and preoperative waiting time in clopidogrel-treated patients.

March 7, 2012Circulation Cardiovascular Interventions

Platelet Function Measurement–Based Strategy to Reduce Bleeding and Waiting Time in Clopidogrel-Treated Patients Undergoing Coronary Artery Bypass Graft Surgery

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Why the study?

Does a platelet function measurement-based strategy reduce bleeding and waiting time in clopidogrel-treated patients undergoing CABG compared to clopidogrel-naive patients?

Population

180 patients on background aspirin with/without clopidogrel therapy undergoing elective first time isolated…

Comparison

Preoperative platelet function testing to… vs Clopidogrel-naive patients undergoing CABG

Design

Cohort, nonrandomized, unblinded

Follow-up

24 hours

Authors

EMElisabeth MahlaMedical University of Graz TSThomas SuarezSanté Publique France KBKevin P. BlidenInterventional Cardiology

Discussion

Member takes

Implication

May support platelet function-guided CABG timing without excess bleeding; leaves open randomized confirmation before changing practice.

Key Points

To determine whether tailoring the timing of coronary artery bypass graft surgery using platelet function testing reduces bleeding and preoperative waiting time in clopidogrel-treated patients.
Prospective single-center, nonrandomized, unblinded interventional investigation (TARGET-CABG, NCT00857155) enrolling 180 patients on aspirin with or without clopidogrel undergoing elective first-time isolated on-pump CABG between September 2008 and January 2011.
Thrombelastography measured ADP-induced platelet-fibrin clot strength (MA(ADP)) to assign surgery timing: within 1 day (>50 mm), 3–5 days (35–50 mm), or >5 days (<35 mm).
The primary endpoint was 24-hour chest tube drainage (equivalence defined as ≤25% difference), and the key secondary endpoint was total red blood cell units transfused, adjusted using ANCOVA.
Mean 24-hour chest tube drainage in clopidogrel-treated patients met equivalence criteria at 93% (95% CI, 81%–107%) of the volume measured in clopidogrel-naive patients.
Total red blood cells transfused did not differ significantly between clopidogrel-treated and clopidogrel-naive cohorts (1.80 U vs 2.08 U, P=0.540).
The total waiting period in clopidogrel-treated patients was 233 days (mean 2.7 days per patient), achieving an approximate 50% reduction in delay compared to guideline recommendations.

Structured PICO

Does a platelet function measurement-based strategy reduce bleeding and waiting time in clopidogrel-treated patients undergoing CABG compared to clopidogrel-naive patients?

Population

180 patients on background aspirin with/without clopidogrel therapy undergoing elective first time isolated on-pump CABG

Intervention

Preoperative platelet function testing (thrombelastography) to determine timing of CABG in clopidogrel-treated patients based on ADP-induced platelet-fibrin clot strength (MA(ADP))

Comparator

Clopidogrel-naive patients undergoing CABG

Outcome

24-hour chest tube drainagesafety

Preoperative platelet function testing to guide CABG timing in clopidogrel-treated patients achieves similar bleeding outcomes to clopidogrel-naive patients while halving the guideline-recommended waiting time.

Cite This Study

Mahla et al. (2012) studied this question.

synapsesocial.com/papers/6a70b3c2e71d69abee08c976 https://doi.org/10.1161/circinterventions.111.967208

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Platelet Function Measurement–Based Strategy to Reduce Bleeding and Waiting Time in Clopidogrel-Treated Patients Undergoing Coronary Artery Bypass Graft Surgery

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Platelet Function Measurement–Based Strategy to Reduce Bleeding and Waiting Time in Clopidogrel-Treated Patients Undergoing Coronary Artery Bypass Graft Surgery

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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