Platelet Reactivity and Outcomes after Off-Pump Coronary Surgery in Acute Coronary Syndrome Patients
Ischemic and hemorrhagic complications are major determinants of survival in acute coronary syndrome (ACS) patients undergoing coronary surgery. We investigated the association of preoperative platelet reactivity to P2Y<sub>12</sub> antagonists with ischemic and hemorrhagic complications...
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MDPI AG
2022-06-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/12/3285 |
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| author | Sarah Soh Yu Rim Shin Jong-Wook Song Jun Hyug Choi Young-Lan Kwak Jae-Kwang Shim |
| author_facet | Sarah Soh Yu Rim Shin Jong-Wook Song Jun Hyug Choi Young-Lan Kwak Jae-Kwang Shim |
| author_sort | Sarah Soh |
| collection | DOAJ |
| description | Ischemic and hemorrhagic complications are major determinants of survival in acute coronary syndrome (ACS) patients undergoing coronary surgery. We investigated the association of preoperative platelet reactivity to P2Y<sub>12</sub> antagonists with ischemic and hemorrhagic complications after Off-Pump Coronary Artery Bypass surgery (OPCAB) in ACS patients who received dual anti-platelet therapy (DAPT) within 5 days prior to surgery. This prospective, observational study with 177 patients compared the incidence of perioperative major bleeding and major adverse cardiac events (MACEs) in relation to the tertile distribution of the % inhibitory response to P2Y<sub>12</sub> antagonists, as measured by a thromboelastography platelet mapping assay. The incidences of perioperative major bleeding and MACEs were similar in relation to the tertile distribution of inhibitory response to P2Y<sub>12</sub> antagonists. The % inhibitory responses to P2Y<sub>12</sub> antagonists between patients who did or did not exhibit MACEs, and with or without major bleeding, were 58 ± 20% and 56 ± 20% (<i>p</i> = 0.578) and 57 ± 19% and 56 ± 21% (<i>p</i> = 0.923), respectively. In ACS patients who received DAPT close to OPCAB, the platelet inhibitory response to P2Y<sub>12</sub> antagonists was not associated with ischemic or hemorrhagic complications. OPCAB may obviate the need for routine platelet function testing for ACS patients requiring DAPT and surgical revascularization. Clinical Registration Number: NCT02184884. |
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| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T23:28:38Z |
| publishDate | 2022-06-01 |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-c1eeaf62e8ea4645a30d6d500e0f30ac2023-11-23T17:13:30ZengMDPI AGJournal of Clinical Medicine2077-03832022-06-011112328510.3390/jcm11123285Platelet Reactivity and Outcomes after Off-Pump Coronary Surgery in Acute Coronary Syndrome PatientsSarah Soh0Yu Rim Shin1Jong-Wook Song2Jun Hyug Choi3Young-Lan Kwak4Jae-Kwang Shim5Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul 03722, KoreaDivision of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul 03722, KoreaDepartment of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul 03722, KoreaDepartment of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul 03722, KoreaDepartment of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul 03722, KoreaDepartment of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul 03722, KoreaIschemic and hemorrhagic complications are major determinants of survival in acute coronary syndrome (ACS) patients undergoing coronary surgery. We investigated the association of preoperative platelet reactivity to P2Y<sub>12</sub> antagonists with ischemic and hemorrhagic complications after Off-Pump Coronary Artery Bypass surgery (OPCAB) in ACS patients who received dual anti-platelet therapy (DAPT) within 5 days prior to surgery. This prospective, observational study with 177 patients compared the incidence of perioperative major bleeding and major adverse cardiac events (MACEs) in relation to the tertile distribution of the % inhibitory response to P2Y<sub>12</sub> antagonists, as measured by a thromboelastography platelet mapping assay. The incidences of perioperative major bleeding and MACEs were similar in relation to the tertile distribution of inhibitory response to P2Y<sub>12</sub> antagonists. The % inhibitory responses to P2Y<sub>12</sub> antagonists between patients who did or did not exhibit MACEs, and with or without major bleeding, were 58 ± 20% and 56 ± 20% (<i>p</i> = 0.578) and 57 ± 19% and 56 ± 21% (<i>p</i> = 0.923), respectively. In ACS patients who received DAPT close to OPCAB, the platelet inhibitory response to P2Y<sub>12</sub> antagonists was not associated with ischemic or hemorrhagic complications. OPCAB may obviate the need for routine platelet function testing for ACS patients requiring DAPT and surgical revascularization. Clinical Registration Number: NCT02184884.https://www.mdpi.com/2077-0383/11/12/3285acute coronary syndromedual anti-platelet therapyoff-pump coronary artery bypass surgeryP2Y<sub>12</sub> antagonist |
| spellingShingle | Sarah Soh Yu Rim Shin Jong-Wook Song Jun Hyug Choi Young-Lan Kwak Jae-Kwang Shim Platelet Reactivity and Outcomes after Off-Pump Coronary Surgery in Acute Coronary Syndrome Patients Journal of Clinical Medicine acute coronary syndrome dual anti-platelet therapy off-pump coronary artery bypass surgery P2Y<sub>12</sub> antagonist |
| title | Platelet Reactivity and Outcomes after Off-Pump Coronary Surgery in Acute Coronary Syndrome Patients |
| title_full | Platelet Reactivity and Outcomes after Off-Pump Coronary Surgery in Acute Coronary Syndrome Patients |
| title_fullStr | Platelet Reactivity and Outcomes after Off-Pump Coronary Surgery in Acute Coronary Syndrome Patients |
| title_full_unstemmed | Platelet Reactivity and Outcomes after Off-Pump Coronary Surgery in Acute Coronary Syndrome Patients |
| title_short | Platelet Reactivity and Outcomes after Off-Pump Coronary Surgery in Acute Coronary Syndrome Patients |
| title_sort | platelet reactivity and outcomes after off pump coronary surgery in acute coronary syndrome patients |
| topic | acute coronary syndrome dual anti-platelet therapy off-pump coronary artery bypass surgery P2Y<sub>12</sub> antagonist |
| url | https://www.mdpi.com/2077-0383/11/12/3285 |
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