Platelet activity measured by a rapid turnaround assay identifies coronary artery bypass grafting patients at increased risk for bleeding and transfusion complications after clopidogrel administration.
J Thorac Cardiovasc Surg
; 146(5): 1259-1266, 1266.e1; discussion 1266, 2013 Nov.
Article
em En
| MEDLINE
| ID: mdl-23953984
ABSTRACT
BACKGROUND:
We sought to establish a metric for easily estimating bleeding and transfusion risks for cardiac surgery patients after antiplatelet agent use.METHODS:
Deidentified records of patients who underwent coronary artery bypass grafting (CABG) at our institution (January 2010-June 2011) were searched for patients without identified risk factors for excessive bleeding who underwent documented P2Y12 testing after clopidogrel administration (n = 276). Clinical outcomes were analyzed according to whether preoperative platelet function was higher (platelet reactivity units [PRUs], ≥237) or lower (PRU, <237) and according to preoperative PRU cutoffs high (>290, or no clopidogrel), intermediate (200-290), or low (<200).RESULTS:
Eighty-five patients (57%) received allogeneic blood products at 24 hours or less postoperatively 33 (22%) received fresh frozen plasma, and 57 (38%) received platelets. The median 12-hour chest tube output (CTO) was 350 mL (interquartile range, 260-490 mL); CTO was "high" (>437 mL) in 62 (42%) of the clopidogrel-treated patients. Lower-PRU patients were more likely to receive coagulation factors (odds ratio [OR], 2.82; P = .0004) and to have high CTO or coagulation factor transfusion (OR, 2.35; P = .02) than higher-PRU patients. Likewise, intermediate- and low-PRU patients had incrementally greater incidences of high CTO (OR, 1.72; P = .002) and coagulation factor transfusion (OR, 2.08; P < .0001) than high-PRU/no clopidogrel patients. High CTO or coagulation factor transfusion was more frequent in intermediate-PRU (OR, 2.67; P = .02) and low-PRU (OR, 5.08; P = .0002) patients than in high-PRU/no clopidogrel patients.CONCLUSIONS:
Among clopidogrel-treated CABG patients, preoperative platelet function testing can identify those at increased risk for postoperative bleeding and transfusion.Palavras-chave
13; 23.1; 24; 54; ACCF; AHA; American College of Cardiology Foundation; American Heart Association; BSA; CABG; CI; CTO; IQR; OR; PCI; PRU; QA; SBU; SQDUG; SQIP; STS; Society of Thoracic Surgeons; Stony Brook University; Surgical Quality Data Users Group; Surgical Quality Improvement Program; body surface area; chest tube output; confidence interval; coronary artery bypass grafting; interquartile range; odds ratio; percutaneous coronary intervention; platelet reactivity units; quality assurance
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Tipo de estudo:
Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2013
Tipo de documento:
Article