TCT-724 Clopidogrel Loading doses result in Favourable Changes in Nitric Oxide (NO) Metabolism in Patients with Stable Angina Undergoing Percutaneous Coronary Intervention (PCI)

Abstract

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.