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An elderly woman with mild von Willebrand's disease presented with acute myocardial infarction. Percutaneous transluminal coronary angioplasty, to mechanically disrupt the thrombus without anticoagulation, was successfully undertaken. Haemostatic cover was also avoided.

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Methods: VERIFY Pre-Op TIMI 45 was a prospective study of 42 patients with indications for coronary angiography subsequently referred for CABG. All patients were therapeutic on clopidogrel. Platelet function was assessed with VerifyNow™ P2Y 12 Reaction Units (PRU). Chest tube output within 24-hours of CABG was stratified by PRU Ն 208, Ն 230, and Ն 275. Results reported as meanϮSD. Results: Median time from last clopidogrel dose to CABG was 4 days (range 1 to 9 days). Patients who held clopidogrel Ͻ 4 days had lower PRU than those who held for Ն 4 days (190Ϯ84 vs. 271Ϯ21 PRU; pϭ0.015). Thresholds of PRU Ն 208 or Ն 275 correlated with less bleeding but did not reach significance (pϭ0.20 and pϭ0.39). Patients with PRU Ն 230 had significantly less chest tube output than those with PRU Ͻ 230 (622Ϯ220 vs. 1028Ϯ676; pϭ0.026) (Figure). Conclusions:The VerifyNow™ P2Y 12 platelet function assay can be used to predict perioperative bleeding in patients exposed to clopidogrel undergoing CABG. A threshold of Ն 230 PRU is associated with less bleeding, and may assist clinicians in optimizing the timing of surgery.

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