Thromboelastography with Platelet Mapping to Optimize Surgical Timing in Coronary Artery Bypass Grafting Patients on P2Y12 Receptor Blockers Therapy.

Autor:	Dambruoso P; Santa Maria Hospital - GVM Care and Research, Bari, Puglia, Italy., Raimondo P; Anesthesia and Intensive Care Unit II, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Bari, Puglia, Italy., Massaro F; Anesthesia and Intensive Care Unit, Ospedale Generale Regionale F. Miulli, Acquaviva delle Fonti, Puglia, Italy., D'Aniello M; Anesthesia and Intensive Care Unit II, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Bari, Puglia, Italy., Di G pinto; Anesthesia and Intensive Care Unit II, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Bari, Puglia, Italy.
Jazyk:	angličtina
Zdroj:	Brazilian journal of cardiovascular surgery [Braz J Cardiovasc Surg] 2024 Oct 22; Vol. e20230292 (e20230292). Date of Electronic Publication: 2024 Oct 22.
DOI:	10.21470/1678-9741-2023-0292
Abstrakt:	Introduction: An increasing number of patients attending coronary artery bypass grafting (CABG) receive preoperative antiplatelet drugs (acetylsalicylic acid, clopidogrel, prasugrel, ticagrelor). The optimal assessment of preoperative platelet function is the aim of this study for a shorter surgical timing in patients undergoing elective coronary artery bypass grafting. Methods: This study was performed on patients presenting for first-time isolated CABG on therapy with an P2Y12 receptor blockers loading dose (clopidogrel [300 mg] or prasugrel [60 mg] or ticagrelor [180 mg]) or P2Y12 receptor blockers maintenance therapy at least for five days (clopidogrel [75 mg once daily], prasugrel [10 mg once daily], ticagrelor [90 mg twice daily]). All patients received simultaneously acetylsalicylate acid (100 mg daily). Exclusion criterion was emergency CABG regardless of preoperative antiplatelet and anticoagulant therapy. All patients' data were recorded in an Excel® file and analyzed using RStudio® software. Results: Forty-eight consecutive adult patients presenting for CABG were enrolled. Preoperative thromboelastography-platelet mapping showed platelet resistance to P2Y12 blockers receptor - 25% for clopidogrel (6/24), 33% for ticagrelor (6/18), 33% for prasugrel (2/6), and this data was useful to obtain a shorter CABG waiting time in comparison with current guidelines (2.7 vs. five days for clopidogrel, 2.5 vs. five days for ticagrelor, 3.3 vs. seven days for prasugrel). Conclusion: Preoperative thromboelastography-platelet mapping is helpful to detect harmful P2Y12 receptor blockers resistance and to minimize CABG waiting time avoiding unnecessary and life-threatening delays.
Databáze:	MEDLINE
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