Platelet Reactivity in Patients With Acute Coronary Syndromes Awaiting Surgical Revascularization

Platelet Reactivity in Patients With Acute Coronary Syndromes Awaiting Surgical Revascularization

Dual antiplatelet therapy is recommended for patients with acute coronary syndromes (ACS). Approximately 10% to 15% of these patients will undergo coronary artery bypass graft (CABG) surgery for index events, and current guidelines recommend stopping clopidogrel at least 5 days before CABG. This wai...

Full description

Saved in:
Bibliographic Details
Published in:Journal of the American College of Cardiology Vol. 77; no. 10; pp. 1277 - 1286
Main Authors: Nakashima, Carlos A.K., Dallan, Luis A.O., Lisboa, Luiz A.F., Jatene, Fabio B., Hajjar, Ludhmila A., Soeiro, Alexandre M., Furtado, Remo H.M., Dalçoquio, Talia F., Baracioli, Luciano M., Lima, Felipe G., Giraldez, Roberto R.C.V., Silva, Bianca A., Costa, Mateus S.S., Strunz, Celia M.C., Dallan, Luis R.P., Barbosa, Carlos J.D.G., Britto, Flavia A.B., Farkouh, Michael E., Gurbel, Paul A., Nicolau, Jose C.
Format: Journal Article
Language:English
Published: United States Elsevier Inc 16-03-2021
Subjects:
acute coronary syndrome
myocardial revascularization
platelet reactivity
NSTEMI
ACS
myocardial revascularization
acute coronary syndrome
STEMI
platelet reactivity
CABG
ADP
MDRD
DAPT
AUC
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Dual antiplatelet therapy is recommended for patients with acute coronary syndromes (ACS). Approximately 10% to 15% of these patients will undergo coronary artery bypass graft (CABG) surgery for index events, and current guidelines recommend stopping clopidogrel at least 5 days before CABG. This waiting time has clinical and economic implications. This study aimed to evaluate if a platelet reactivity-based strategy is noninferior to standard of care for 24-h post-CABG bleeding. In this randomized, open label noninferiority trial, 190 patients admitted with ACS with indications for CABG and on aspirin and P2Y12 receptor inhibitors, were assigned to either control group, P2Y12 receptor inhibitor withdrawn 5 to 7 days before CABG, or intervention group, daily measurements of platelet reactivity by Multiplate analyzer (Roche Diagnostics GmbH, Vienna, Austria) with CABG planned the next working day after platelet reactivity normalization (pre-defined as ≥46 aggregation units). Within the first 24 h of CABG, the median chest tube drainage was 350 ml (interquartile range [IQR]: 250 to 475 ml) and 350 ml (IQR: 255 to 500 ml) in the intervention and control groups, respectively (p for noninferiority <0.001). The median waiting period between the decision to undergo CABG and the procedure was 112 h (IQR: 66 to 142 h) and 136 h (IQR: 112 to 161 h) (p < 0.001), respectively. In the intention-to-treat analysis, a 6.4% decrease in the median in-hospital expenses was observed in the intervention group (p = 0.014), with 11.2% decrease in the analysis per protocol (p = 0.003). A strategy based on platelet reactivity-guided is noninferior to the standard of care in patients with ACS awaiting CABG regarding peri-operative bleeding, significantly shortens the waiting time to CABG, and decreases hospital expenses. (Evaluation of Platelet Aggregability in the Release of CABG in Patients With ACS With DAPT; NCT02516267) [Display omitted]
Bibliography:ObjectType-Article-2
SourceType-Scholarly Journals-1
ObjectType-Undefined-1
ObjectType-Feature-3
content type line 23
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2021.01.015