Platelet Reactivity Unit in Predicting Risk of Bleeding in Patients Undergoing Coronary Artery Bypass Graft Surgery

Abstract

Bleeding is a common complication of cardiac surgery, accounting for a significant proportion of the total transfusions performed in the United States and Europe. The relationship between platelet reactivity, bleeding, and other adverse events after coronary artery bypass graft surgery (CABGS) has been incompletely characterized. This study investigated the relationship between platelet reactivity and bleeding as a clinical outcome after successful CABGS. A total of 238 patients who underwent CABGS were retrospectively followed for postoperative bleeding. Platelet reactivity unit (PRU) values for all patients were obtained preoperatively to assess the platelet reactivity. The data showed that a range of 180-200 PRU suggests the likelihood of bleeding after CABGS (P = 0.004), with a statistically significant association only for dual antiplatelet therapy with aspirin and clopidogrel. In conclusion, by using PRU values as a method to assess platelet reactivity and antiplatelet responsiveness, our findings suggest that it may be possible to stratify patients undergoing CABGS for the risk of postoperative bleeding particularly patients on dual antiplatelet therapy.

Impact of Cytochrome P450 2C19*2 and *3 on Clopidogrel Loading Dose in Saudi Patients with Acute Coronary Syndrome

“…A considerably more conservative range of 179–200 units (upper limit, 238) was proposed for patients undergoing PCI based on ischemic or bleeding events [ 25 , 26 ]. In addition, a range of 180–200 (upper limit, 230) was suggested for patients with coronary artery bypass grafting (CABG) [ 27 , 28 ]. Furthermore, the developers of the VerifyNow ® P2Y12 assay have specified 194–418 as the normal PRU range, which can be measured ≥6 hours post bolus drug administration (Accumetrics).…”

Aspirin to Reduce the Risk of Thrombotic Events in Patients With End-Stage Renal Disease: Protocol for a Randomized Controlled Trial (Preprint)

“…This discrepancy may be explained by the fact that the mechanism of aspirin-related bleeding adverse events is not yet fully understood. Some authors suggest that the prophylactic efficacy of aspirin and the risk of bleeding related to this drug may be influenced by a phenomenon of platelet hyper-reactivity (17). However, further research is necessary to establish the real impact of platelet hyper-reactivity on the aspirin safety profile in ESRD patients.…”

The Use of Aspirin to Reduce the Risk of Thrombotic Events in Patients With End-Stage Renal Disease: Protocol for a Randomized Controlled Trial

“…This discrepancy highlights the fact that the mechanism of aspirin-related bleeding events is not yet fully understood. Some authors have suggested that the prophylactic efficacy of aspirin and risk of bleeding related to this drug may be influenced by a phenomenon of platelet hyperreactivity [ 16 ]. However, further research is necessary to establish the real impact of platelet hyperreactivity on aspirin’s safety profile in patients with ESRD.…”