Key result
New generation P2Y12 inhibitors prasugrel and ticagrelor have a larger antiplatelet effect and higher risk for bleeding complications compared to clopidogrel in cardiac surgery patients.
This review highlights the need for careful perioperative management of antiplatelet therapy and the potential utility of platelet function testing to balance thromboembolic and bleeding risks in cardiac surgery.
Perioperative antiplatelet decisions in CAD warrant individualized risk-benefit assessment; review leaves open standardized protocols for prasugrel and ticagrelor.
Antiplatelet therapy with acetylsalicylic acid, alone or in combination with a P2Y12 inhibitor, reduces thromboembolic events in patients with coronary artery disease but increases the risk for spontaneous and perioperative bleeding complications. Both the antiplatelet effect and the risk for bleeding complications are larger with the new generation P2Y12 inhibitors prasugrel and ticagrelor than with clopidogrel. In this review, the perioperative handling of acetylsalicylic acid and the P2Y12 inhibitors clopidogrel, prasugrel, and ticagrelor will be discussed. In addition, the concept of platelet function testing in the surgical setting will be covered.
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Jeppsson et al. (2017) conducted a review in Coronary artery disease in cardiac surgery patients. Antiplatelet therapy (acetylsalicylic acid and P2Y12 inhibitors) was evaluated. New generation P2Y12 inhibitors prasugrel and ticagrelor have a larger antiplatelet effect and higher risk for bleeding complications compared to clopidogrel in cardiac surgery patients.
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