BACKGROUND: Predicting bleeding events in patients with coronary artery bypass grafting (CABG) represents an unmet medical need that may improve CABG outcomes. HYPOTESIS: To assess the potential link between platelet function testing and bleeding risk in patients undergoing CABG. METHODS: Platelet aggregation and clinical outcomes in 478 patients treated with aspirin and/or clopidogrel were retrospectively analyzed. Platelet activity was assessed prior to CABG with arachidonic acid (ASPI Test), and adenosine diphosphate(ADP Test) utilizing multiple-electrode aggregometry. RESULTS: In the study group of 478 patients, mean age was 65.2±15.2 years; 138 were women. The majority of patients (n = 198) underwent on-pump surgery, with 162 undergoing off-pump and 30 undergoing minimally invasive surgery. Forty-eight patients received artificial valve implantation alone, and 40 received valve implantation in combination with CABG. The analysis of the entire pool revealed that an ASPI test value <407 area under curve per minute (AUC*min) may be useful in predicting postoperative drainage. In CABG patients only, an ASPI test value <271 AUC*min predicted the need for red blood cell concentrate transfusion following surgery. In patients who stopped clopidogrel for up to 5 days before surgery, the ADP test failed to exhibit prognostic utility for predicting bleeding risk. CONCLUSIONS: In patients undergoing heart surgery, an ASPI test value <407 AUC*min may predict higher postoperative drainage, whereas <271 AUC*min may be linked to postoperative use of red blood cell concentrate.
BACKGROUND: Predicting bleeding events in patients with coronary artery bypass grafting (CABG) represents an unmet medical need that may improve CABG outcomes. HYPOTESIS: To assess the potential link between platelet function testing and bleeding risk in patients undergoing CABG. METHODS: Platelet aggregation and clinical outcomes in 478 patients treated with aspirin and/or clopidogrel were retrospectively analyzed. Platelet activity was assessed prior to CABG with arachidonic acid (ASPI Test), and adenosine diphosphate(ADP Test) utilizing multiple-electrode aggregometry. RESULTS: In the study group of 478 patients, mean age was 65.2±15.2 years; 138 were women. The majority of patients (n = 198) underwent on-pump surgery, with 162 undergoing off-pump and 30 undergoing minimally invasive surgery. Forty-eight patients received artificial valve implantation alone, and 40 received valve implantation in combination with CABG. The analysis of the entire pool revealed that an ASPI test value <407 area under curve per minute (AUC*min) may be useful in predicting postoperative drainage. In CABG patients only, an ASPI test value <271 AUC*min predicted the need for red blood cell concentrate transfusion following surgery. In patients who stopped clopidogrel for up to 5 days before surgery, the ADP test failed to exhibit prognostic utility for predicting bleeding risk. CONCLUSIONS: In patients undergoing heart surgery, an ASPI test value <407 AUC*min may predict higher postoperative drainage, whereas <271 AUC*min may be linked to postoperative use of red blood cell concentrate.
Authors: Kim A Eagle; Robert A Guyton; Ravin Davidoff; Fred H Edwards; Gordon A Ewy; Timothy J Gardner; James C Hart; Howard C Herrmann; L David Hillis; Adolph M Hutter; Bruce Whitney Lytle; Robert A Marlow; William C Nugent; Thomas A Orszulak Journal: Circulation Date: 2004-10-05 Impact factor: 29.690
Authors: Victor A Ferraris; Suellen P Ferraris; David J Moliterno; Philip Camp; Jeanine M Walenga; Harry L Messmore; Walter P Jeske; Fred H Edwards; David Royston; David M Shahian; Eric Peterson; Charles R Bridges; George Despotis Journal: Ann Thorac Surg Date: 2005-04 Impact factor: 4.330
Authors: Marcel M C Hovens; Jaapjan D Snoep; Jeroen C J Eikenboom; Johanna G van der Bom; Bart J A Mertens; Menno V Huisman Journal: Am Heart J Date: 2007-02 Impact factor: 4.749
Authors: Milo C Engoren; Robert H Habib; Anoar Zacharias; Thomas A Schwann; Christopher J Riordan; Samuel J Durham Journal: Ann Thorac Surg Date: 2002-10 Impact factor: 4.330
Authors: N Rahe-Meyer; M Winterhalter; A Boden; C Froemke; S Piepenbrock; A Calatzis; C Solomon Journal: Acta Anaesthesiol Scand Date: 2009-02 Impact factor: 2.105
Authors: Jaapjan D Snoep; Marcel M C Hovens; Jeroen C J Eikenboom; Johanna G van der Bom; J Wouter Jukema; Menno V Huisman Journal: Am Heart J Date: 2007-08 Impact factor: 4.749