Comparison of patient intake of ticagrelor, prasugrel, or clopidogrel on restoring platelet function by donor platelets

Scharbert, Gisela; Wetzel, Léonore; Schrottmaier, Waltraud C.; Kral, Julia B.; Weber, Thomas; Assinger, Alice

doi:10.1111/trf.12977

Cited by 23 publications

(18 citation statements)

References 21 publications

(37 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In this study, patients were even treated with loading doses of aspirin (325 mg) and clopidogrel (600 mg) [29]. In addition to clinical data, there is solid in vitro evidence clearly demonstrating that platelet transfusions have a dosedependent effect on impaired platelet function and have the potential to completely restore impaired platelet function due to ASA, clopidogrel or prasugrel intake [8,9,22].…”

Section: Discussionmentioning

confidence: 96%

High prevalence of pharmacologically induced platelet dysfunction in the acute setting of brain injury

et al. 2015

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 96%

High prevalence of pharmacologically induced platelet dysfunction in the acute setting of brain injury

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Scharbert et al . investigated the effect of plasma from clopidogrel‐ ( n = 5), prasugrel‐ ( n = 7), and ticagrelor‐treated patients ( n = 7) on platelet function of blood from healthy volunteers by flow cytometry, LTA, and impedance aggregometry. All three P2Y 12 receptor inhibitors diminished the response to ADP as evaluated by platelet surface expression of P‐selectin.…”

Section: Platelet Transfusions To Patients On Antiplatelet Therapymentioning

confidence: 99%

Oral antiplatelet therapy: impact for transfusion medicine

Gremmel

Panzer

2017

Vox Sanguinis

View full text Add to dashboard Cite

Patients on antiplatelet therapy, be it aspirin only, or aspirin in combination with oral adenosine diphosphate (ADP) receptor inhibitors like clopidogrel, prasugrel and ticagrelor, or the protease-activated receptor-1 inhibitor vorapaxar, may develop bleeding or need transient reversal of platelet blockade for acute interventions. In this review, we summarize reports on patients with antiplatelet therapy receiving platelet concentrates due to bleeding, and in vitro experiments estimating the feasibility to restore platelet function by spiking blood from healthy individuals or patients on antiplatelet treatment with noninhibited platelets. So far, all clinical data were gained from patients on aspirin with or without ADP P2Y receptor inhibitors. Platelet inhibition due to clopidogrel, and to some extent also prasugrel may be overcome by platelet transfusion, but clinical data on massive platelet transfusion in these patients are lacking. Platelet transfusion may even be associated with worse outcomes. Ticagrelor-mediated platelet inhibition remains a challenge, as case reports show that platelet transfusion did not restore haemostasis. Prescription of the latter therefore demands a particular stringent indication.

show abstract

“…The observed effects were due to Ticagrelor and not elevated adenosine concentrations in the patient’s plasma. A modified multiple electrode aggregometry (MEA) assay can be used to determine whether the patient would be likely to benefit from platelet (PLT) transfusions[68]. …”

Section: Perioperative Managementmentioning

confidence: 99%

Organ transplantation and drug eluting stents: Perioperative challenges

Dalal¹

2016

WJT

View full text Add to dashboard Cite

Patients listed for organ transplant frequently have severe coronary artery disease (CAD), which may be treated with drug eluting stents (DES). Everolimus and zotarolimus eluting stents are commonly used. Newer generation biolimus and novolimus eluting biodegradable stents are becoming increasingly popular. Patients undergoing transplant surgery soon after the placement of DES are at increased risk of stent thrombosis (ST) in the perioperative period. Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor such as clopidogrel, prasugrel and ticagrelor is instated post stenting to decrease the incident of ST. Cangrelor has recently been approved by Food and Drug Administration and can be used as a bridging antiplatelet drug. The risk of ischemia vs bleeding must be considered when discontinuing or continuing DAPT for surgery. Though living donor transplant surgery is an elective procedure and can be optimally timed, cadaveric organ availability is unpredictable, therefore, discontinuation of antiplatelet medication cannot be optimally timed. The type of stent and timing of transplant surgery can be of utmost importance. Many platelet function point of care tests such as Light Transmittance Aggregrometry, Thromboelastography Platelet Mapping, VerifyNow, Multiple Electrode Aggregrometry are used to assess bleeding risk and guide perioperative platelet transfusion. Response to allogenic platelet transfusion to control severe intraoperative bleeding may differ with the antiplatelet drug. In stent thrombosis is an emergency where management with either a drug eluting balloon or a DES has shown superior outcomes. Post-transplant complications often involved stenosis of an important vessel that may need revascularization. DES are now used for endovascular interventions for transplant orthotropic heart CAD, hepatic artery stenosis post liver transplantation, transplant renal artery stenosis following kidney transplantation, etc. Several antiproliferative drugs used in the DES are inhibitors of mammalian target of rapamycin. Thus they are used for post-transplant immunosuppression to prevent acute rejection in recipients with heart, liver, lung and kidney transplantation. This article describes in detail the various perioperative challenges encountered in organ transplantation surgery and patients with drug eluting stents.

show abstract

Comparison of patient intake of ticagrelor, prasugrel, or clopidogrel on restoring platelet function by donor platelets

Abstract: Our results provide novel insights into potential differences between the P2Y12 inhibitors on donor PLT function in an in vitro setting, which may provide implications for future PLT transfusion strategies in these patients.

Cited by 23 publications

References 21 publications

High prevalence of pharmacologically induced platelet dysfunction in the acute setting of brain injury

High prevalence of pharmacologically induced platelet dysfunction in the acute setting of brain injury

Oral antiplatelet therapy: impact for transfusion medicine

Organ transplantation and drug eluting stents: Perioperative challenges

Contact Info

Product

Resources

About