Bleeding risk assessment using multiple electrode aggregometry in patients following coronary artery bypass surgery

Petričević, Mate; Biočina, Bojan; Miličić, Davor; Konosić, Sanja; Ivančan, Višnja; Milošević, Milan; Burcar, Ivan; Gašparović, Hrvoje

doi:10.1007/s11239-012-0798-3

Cited by 49 publications

(81 citation statements)

References 19 publications

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“…These results are consistent with other studies of perioperative bleeding and aspirin responsiveness testing prior to CABG. 2 Thus, the importance of aspirin responsiveness has not been overlooked by our group and is being further investigated.…”

Section: To the Editormentioning

confidence: 96%

Authors' Reply

Reed

Guo

Cannon

et al. 2015

Clinical Cardiology

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Section: To the Editormentioning

confidence: 96%

Authors' Reply

Reed

Guo

Cannon

et al. 2015

Clinical Cardiology

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“…Consequently, with class IIb and level B of evidence, platelet function testing has the status "May be considered" which in the absence of stronger evidence somehow underestimates the real possibilities of this kind of technology in patient care. While much of the literature on point-of-care platelet function tests focuses on assessing their utility in guiding long term APT, these devices have an additional role in cardiac surgery as they can assess bleeding risk and transfusion requirements [4][5][6]. The evidence for a therapeutic window targeting optimal on-treatment platelet reactivity to prevent both bleeding and ischemic events is emerging.…”

Section: Introductionmentioning

confidence: 99%

“…Based upon our own clinical and research experience using multiple electrode aggregometry (MEA) (Multiplate® ; Roche Diagnostics, Mannheim, Germany) in this particular field [2][3][4][5][6][7][8][9][10][11][12][13], we sought to define pre-and post CAS therapeutic window for the most commonly administered APT such as aspirin and adenosine di-phosphate receptor blockers.…”

Section: Introductionmentioning

confidence: 99%

Development of a concept for a personalized approach in the perioperative antiplatelet therapy administration/discontinuation management based on multiple electrode aggregometry in patients undergoing coronary artery surgery

Petričević

Miličić

White

et al. 2015

J Thromb Thrombolysis

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administration/discontinuation management. Despite emerging evidence on the widespread variability in platelet inhibitory response to APT, numerous PFT devices and heterogeneity in reporting study results hamper pooling of the evidence which in turn results with a lack of consensus in "on treatment" platelet reactivity associated with ischemic and bleeding events in perioperative phase. MethodsThe literature on multiple electrode aggregometry (Multiplate® ; Roche Diagnostics, Mannheim, Germany) in coronary artery disease patients was reviewed systematically. Based on the evidence evaluating the relationship between "drug specific" PFT and bleeding or adverse ischemic events, we sought to define therapeutic window for the most commonly administered antiplatelet drugs such as aspirin (ASPI test) and adenosine-diphosphate receptor blockers (ADP test). ResultsPreoperatively, APT administration was primarily focused to avoid bleeding complications.ASPI test value of 20 AUC and ADP test value of <73 AUC were set as cut-off values that delineate bleeding tendency. Postoperatively, "therapeutic window" was set to avoid both 3 bleeding and adverse ischemic events. Therapeutic ranges were as follows: 20AUC

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“…Our working group recently found that platelet ADP activity varies widely among patients exposed to clopidogrel, and corresponds to the extent of postoperative bleeding [3,4]. The effect of ADP receptor blockers depends on (1) baseline, inherent platelet ADP receptor activity, (2) platelet inhibitory response to antiplatelet drug, as well as on (3) recovery rate of platelet function after drug discontinuation.…”

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confidence: 99%

“…According to predefined ADP test value cutoff's (uniformly applicable to patients exposed to either clopidogrel or prasugrel) [4] it would be possible to stratify patients in regard to bleeding risk. In addition to, recovery of platelet function following drug discontinuation could be quantified by serial platelet function testing and once platelet function outgrows predefined cutoff value that delineates bleeding tendency it would be safe to proceed with surgery regardless the number of days following drug cessation.…”

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confidence: 99%