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...

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Published in:Journal of the American College of Cardiology 2021-03, Vol.77 (10), p.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.
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Language:English
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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for CABG and on aspirin and P2Y12 receptor inhibitors, were assigned to either control group, P2Y12 receptor inhibitor withdrawn 5 to 7 days before CABG, or intervention group, daily measurements of platelet reactivity by Multiplate analyzer (Roche Diagnostics GmbH, Vienna, Austria) with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 
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2021.01.015