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Mahla, E; Tantry, US; Prüller, F; Gurbel, PA.
Is There a Role for Preoperative Platelet Function Testing in Patients Undergoing Cardiac Surgery During Antiplatelet Therapy?
Circulation. 2018; 138(19):2145-2159 Doi: 10.1161/CIRCULATIONAHA.118.035160
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Leading authors Med Uni Graz: Mahla Elisabeth
Co-authors Med Uni Graz: Prüller Florian
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Abstract:: Up to 11% of patients presenting with acute coronary syndromes undergo coronary artery bypass grafting. Guidelines largely recommend a one-size-fits-all preoperative discontinuation period for P2Y₁₂ receptor blockers to avoid bleeding. These recommendations do not account for highly variable pharmacodynamic responsiveness and for variable recovery of platelet reactivity following discontinuation of P2Y₁₂ receptor blockers. Several observational studies have demonstrated that an objective measurement of platelet function among these patients may reduce the waiting period while mitigating the risk of bleeding. Based on these findings, 2 recent guidelines included a Class IIa and IIb recommendation for platelet function testing in patients undergoing cardiac surgery. The following review article describes the rationale for discontinuation of dual antiplatelet therapy before cardiac surgery and the limitations with this approach, available platelet function assays to assess pharmacodynamic effects, and the association between platelet inhibition and other clinical factors with surgery-related bleeding. The information will assist the reader in determining which patients undergoing cardiac surgery might benefit from preoperative platelet function monitoring.
Find related publications in this database (using NLM MeSH Indexing): Blood Loss, Surgical - prevention & control; Blood Platelets - drug effects; Blood Platelets - metabolism; Cardiac Surgical Procedures - adverse effects; Drug Administration Schedule -; Drug Monitoring - methods; Drug Therapy, Combination -; Humans -; Platelet Aggregation Inhibitors - administration & dosage; Platelet Aggregation Inhibitors - adverse effects; Platelet Function Tests -; Postoperative Hemorrhage - blood; Postoperative Hemorrhage - etiology; Postoperative Hemorrhage - prevention & control; Predictive Value of Tests -; Preoperative Care - methods; Purinergic P2Y Receptor Antagonists - administration & dosage; Purinergic P2Y Receptor Antagonists - adverse effects; Receptors, Purinergic P2Y12 - blood; Receptors, Purinergic P2Y12 - drug effects; Risk Assessment -; Risk Factors -; Treatment Outcome -
Find related publications in this database (Keywords): cardiac surgical procedures; hemorrhage; platelet aggregation inhibitors; platelet function tests; purinergic P2Y(12) receptor antagonists