Clopidogrel and bleeding in patients undergoing elective coronary artery bypass grafting

Chen, Liqian; Radovancevic, Rajko; Cooper, John R.; Collard, Charles D.; Vaughn, William K.; Nussmeier, Nancy A.

doi:10.1016/j.jtcvs.2004.02.019

Cited by 190 publications

(108 citation statements)

References 29 publications

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“…The surgery was successful, clopidogrel and aspirin were restarted eight hours later with loading doses, and the patient did not experience any thrombotic or bleeding events during the perioperative period [19]. Small studies have shown that adenosine diphosphate aggregometry, multiple electrode platelet aggregometry, and thromboelastography platelet mapping may be able to predict bleeding risks for patients receiving coronary artery bypass grafts (CABG) [20][21][22]. However, one of those studies showed that the point-of-care tests Platelet Function Analyzer 100 and Platelet Works were not predictive of which patients receiving CABG would bleed [20].…”

Section: Discussionmentioning

confidence: 99%

“…Small studies have shown that adenosine diphosphate aggregometry, multiple electrode platelet aggregometry, and thromboelastography platelet mapping may be able to predict bleeding risks for patients receiving coronary artery bypass grafts (CABG) [20][21][22]. However, one of those studies showed that the point-of-care tests Platelet Function Analyzer 100 and Platelet Works were not predictive of which patients receiving CABG would bleed [20]. The VerifyNow P2Y 12 Test has not yet been studied to predict bleeding risks in CABG or other surgeries in patients taking clopidogrel [17].…”

Section: Discussionmentioning

confidence: 99%

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Characterization and Evaluation of Clopidogrel Response Testing in a Community Hospital Setting

Lalama¹

2011

J Clinic Experiment Cardiol

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Purpose: To describe how VerifyNow P2Y 12 testing for clopidogrel response is being utilized at a community hospital.Methods: A retrospective chart review was conducted at a 411-bed community hospital in patients who tested positive for poor clopidogrel response.Results: There were 95 positive P2Y 12 tests evaluated in this study. Positive P2Y 12 tests were obtained 40.0% of the time for cardiovascular indications, 28.4% for neurologic indications, 1.1% for hematologic indications, and 30.5% were obtained to evaluate patients prior to surgery. The medication regimens of 38.8% of patients did not change as a result of a positive test for poor clopidogrel response. The clopidogrel dose was increased in 16.3% of patients, and clopidogrel was discontinued in 10.2% of patients positive for poor clopidogrel response not undergoing surgical evaluation. Rehospitalization rates of non-surgical patients for recurrent thrombosis or bleeding at 90 days were highest for patients who had an additional antiplatelet agent or anticoagulant added due to poor clopidogrel response. The lowest rehospitalization rate was seen in patients switched to an alternative agent. Conclusions:The most common findings after a positive P2Y 12 test in non-surgical patients were no change in therapy and increasing the dose of clopidogrel. Adding an additional antiplatelet agent or anticoagulant was associated with the highest risk of rehospitalization.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Characterization and Evaluation of Clopidogrel Response Testing in a Community Hospital Setting

Lalama¹

2011

J Clinic Experiment Cardiol

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“…We identified bleeding events in 12% of 201 subjects with aggregation rates of 20%, which was comparable to the bleeding event rate for an INR of 3.0-4.4 in Italian subjects taking warfarin 14) . Chen and colleagues 15) examined the relationship between platelet aggregation and bleeding during coronary bypass grafting and found that patients who had greater clopidogrel-induced platelet inhibition required a significantly higher number of platelet and red blood cell transfusions than patients with lower clopidogrel-induced platelet inhibition. This may support our major result, suggesting the possibility of using a platelet function assay as a tool for the risk stratification of bleeding events.…”

Section: Discussionmentioning

confidence: 99%

Platelet Function Measured Using a Whole Blood Aggregometer Can Predict Bleeding Events

Sairaku¹,

Nakano

Eno³

et al. 2011

JAT

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Aim:We hypothesized that excessive suppression of platelet function due to antiplatelet therapy can increase the incidence of bleeding complications. The aim of the present study was to find whether we could predict bleeding events by measuring platelet function. Methods: We enrolled 743 subjects whose platelet function was measured using a whole blood aggregometer based on a screen filtration pressure method. Of these subjects, 551 (74.2%) were treated with some type of antiplatelet agent. The endpoints were bleeding or ischemic events requiring hospitalization or extension of hospital stay. We prospectively compared the platelet function of subjects with and without bleeding or ischemic events.

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“…Current guidelines recommend that aspirin be continued until the time of surgery as RCTs have indicated that, although this increases blood loss marginally, there are no serious adverse events attributable to this blood loss and there are clear benefits in terms of fewer adverse cardiovascular events prior to surgery. 60 Observational analyses demonstrate more severe bleeding and adverse events attributable to platelet inhibition with DAPT relative to aspirin alone 61,62 and current guidelines (class I recommendation, evidence level B) recommend that P2Y 12 receptor antagonists be stopped 3-5 days prior to surgery. 24 This empirical approach is not without risk; many patients may be left at increased risk of adverse cardiovascular events prior to surgery and this is not detected by observational studies that commonly analyse events from surgery, a form of lead time bias.…”

Section: Antiplatelet Agentsmentioning

confidence: 99%

Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery: systematic reviews, observational studies and randomised controlled trials

Murphy

Mumford

Rogers

et al. 2017

Programme Grants Appl Res

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This report should be referenced as follows:Murphy GJ, Mumford AD, Rogers CA, Wordsworth S, Stokes EA, Verheyden V, et al. Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery: systematic reviews, observational studies and randomised controlled trials. Programme Grants Appl Res 2017;5(17). Programme Grants for Applied ResearchISSN 2050-4322 (Print) ISSN 2050-4330 (Online) This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: journals.library@nihr.ac.ukThe full PGfAR archive is freely available to view online at www.journalslibrary.nihr.ac.uk/pgfar. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Programme Grants for Applied Research journalReports are published in Programme Grants for Applied Research (PGfAR) if (1) they have resulted from work for the PGfAR programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. Programme Grants for Applied Research programmeThe Programme Grants for Applied Research (PGfAR) programme, part of the National Institute for Health Research (NIHR), was set up in 2006 to produce independent research findings that will have practical application for the benefit of patients and the NHS in the relatively near future. The Programme is managed by the NIHR Central Commissioning Facility (CCF) with strategic input from the Programme Director.The programme is a national response mode funding scheme that aims to provide evidence to improve health outcomes in England through promotion of health, prevention of ill health, and optimal disease management (including safety and quality), with particular emphasis on conditions causing significant disease burden.For more information about the PGfAR programme please visit the website: http://www.nihr.ac.uk/funding/programme-grants-forapplied-research.htm This reportThe research reported in this issue of the journal was funded by PGfAR as project number RP-PG-0407-10384. The contractual start date was in July 2008. The final report began editorial review in July 2016 and was accepted for publication in April 2017. As the funder, the PGfAR programme agreed the research questions and study designs in advance with the investigators. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The PGfAR editors and production house have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the final report document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not ...

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Clopidogrel and bleeding in patients undergoing elective coronary artery bypass grafting

Cited by 190 publications

References 29 publications

Characterization and Evaluation of Clopidogrel Response Testing in a Community Hospital Setting

Characterization and Evaluation of Clopidogrel Response Testing in a Community Hospital Setting

Platelet Function Measured Using a Whole Blood Aggregometer Can Predict Bleeding Events

Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery: systematic reviews, observational studies and randomised controlled trials

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