Key result
Preoperative point-of-care platelet function assessment (PRU ≤ 207) discriminated between patients with and without major bleeding during CABG surgery (AUC 0.76; 95% CI 0.59-0.94; P=0.018).
Why the study?
Does preoperative point-of-care platelet function testing predict bleeding in patients exposed to clopidogrel undergoing CABG?
Cohort (n=39)
Does preoperative point-of-care platelet function testing predict bleeding in patients exposed to clopidogrel undergoing CABG?
Effect estimate: AUC 0.76 (95% CI 0.59-0.94)
p-value: p=0.018
Preoperative point-of-care platelet function testing can predict bleeding risk in patients on clopidogrel undergoing CABG, potentially allowing for individualized timing of surgery rather than a standard 5-day wait.
May support bleeding risk stratification before CABG on clopidogrel; leaves open prospective validation before changing surgical timing.
BACKGROUND: Guidelines recommend delaying coronary artery bypass grafting (CABG) for 5 days after discontinuing clopidogrel. However, platelet function may recover quicker in certain individuals. HYPOTHESIS: We hypothesized that perioperative measurement of platelet function with a point-of-care P2Y12 inhibitor assay could predict bleeding during CABG in patients exposed to clopidogrel. METHODS: Verify Pre-Op TIMI 45 was a prospective pilot study of 39 patients on clopidogrel who subsequently underwent CABG. Preoperative on-treatment platelet reactivity was assessed with VerifyNow P2Y12 Reaction Units (PRU), with higher PRU indicating more reactive platelets. Outcomes were stratified by PRU quartiles, as well as prespecified cutpoints for the lowest quartile (PRU 173), a cutpoint for major bleeding determined by the Youden index using receiver operator curve analysis (PRU 207), and clopidogrel resistance (PRU 230). RESULTS: Patients in higher PRU quartiles experienced smaller decreases in hemoglobin and hematocrit (P < 0.05 for all comparisons), less major bleeding (P = 0.021), and less major or minor bleeding (P = 0.003). Patients above the PRU 207 and 230 cutpoints had less chest-tube output (P = 0.041 and P = 0.012, respectively), less major bleeding (P = 0.005 and P = 0.036, respectively), and less major or minor bleeding (P = 0.013 and P < 0.001, respectively). By receiver operator curve analysis, preoperative PRU ≤ 207 discriminated between patients with and without major bleeding during surgery (area under the curve: 0.76, 95% confidence interval: 0.59-0.94, P = 0.018). CONCLUSIONS: In this pilot study, we found that point-of-care platelet function assessment could predict bleeding in patients recently exposed to clopidogrel undergoing CABG.
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Reed et al. (2015) conducted a cohort in Patients on clopidogrel undergoing CABG (n=39). Preoperative on-treatment platelet reactivity (PRU) vs. Higher PRU quartiles/cutpoints was evaluated on Major bleeding during surgery (AUC 0.76, 95% CI 0.59-0.94, p=0.018). Preoperative point-of-care platelet function assessment (PRU ≤ 207) discriminated between patients with and without major bleeding during CABG surgery (AUC 0.76; 95% CI 0.59-0.94; P=0.018).
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