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Platelet inhibitory response to clopidogrel predicted increased blood loss after off-pump CABG
Kwak Y. J Am Coll Cardiol. 2010;56:1994-2002.
Montalescot G. J Am Coll Cardiol. 2010;56:2003-2005.
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Regardless of the proximity of clopidogrel exposure, a high percentage of platelet inhibitory response to clopidogrel was predictive of increased blood loss and transfusion requirements after off-pump CABG in patients, study findings indicated.
The study included 100 prospectively enrolled patients who received clopidogrel within 5 days of off-pump CABG. Patients were split evenly between two arms: those given aspirin and clopidogrel treatment until 1 day and 3 days before surgery. They defined the primary endpoint as the comparison between postoperative bleeding and transfusion requirement in relation to the tertile distribution of the percentage of platelet inhibitory response to clopidogrel.
According to results, blood loss for patients in the third tertile was higher compared with those in the first and second tertiles (914 ± 264 mL vs. 623 ± 249 mL, 683 ± 254 mL; P=.001). More patients in the third tertile had transfusions, as well as an 11-fold higher risk for transfusion after multivariate analysis (latter trend, P=.001).
Additionally, researchers determined the optimal cutoff for the transfusion requirement was 70% platelet inhibitory response to clopidogrel.
“Regardless of the proximity of clopidogrel exposure, patients exhibiting a percentage of platelet inhibitory response to clopidogrel <70% may safely undergo [off-pump] CABG without an increased risk of transfusion requirement,” Young-Lan Kwak, MD, PhD, and colleagues said, adding that the findings may also implicate a potential role of modified thromboelastography in deciding the timing of off-pump CABG in patients who need continued antiplatelet therapy without forfeiting the ischemic benefit.
In an accompanying editorial, Gilles Montalescot, MD, PhD, Jean-Sébastien Hulot, MD, and Jean-Philippe Collet, MD, PhD, said the risk for bleeding associated with CABG does not obviate the need for clinical trials evaluating other hard endpoints.
“A series of small studies, such as the one reported by Kwak et al, could collectively draw awareness and lead to rigorous exploration of the platelet issues linked to CABG indication,” they said. “The new diagnostic tools and the new drugs may help to generate concerted scientific action with anesthetists and cardiac surgeons.”
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