Platelet inhibition and bleeding complications in cardiac surgery: A review

Area of Science:

• Cardiology
• Vascular Surgery
• Pharmacology

Background:

• Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is standard for acute coronary syndrome (ACS).
• DAPT increases bleeding risk, particularly in patients undergoing cardiac surgery.
• Excessive bleeding post-cardiac surgery leads to higher morbidity, mortality, and healthcare costs.

Purpose of the Study:

• To review the perioperative management of antiplatelet therapy in cardiac surgery patients.
• To discuss the impact of platelet inhibition on bleeding and transfusion needs.
• To explore strategies for drug discontinuation, reintroduction, and the role of platelet function testing.

Main Methods:

• Literature review of studies on DAPT in cardiac surgery.
• Analysis of bleeding complications and transfusion requirements associated with antiplatelet agents.
• Examination of protocols for perioperative antiplatelet drug management.

Main Results:

• DAPT effectively reduces thrombotic events in ACS patients.
• Perioperative management of DAPT is complex, balancing ischemic and bleeding risks.
• Platelet function testing may aid in guiding perioperative management decisions.

Conclusions:

• Optimizing DAPT management around cardiac surgery is crucial for patient outcomes.
• Careful consideration of drug discontinuation and reinitiation is necessary.
• Further research into perioperative platelet function monitoring is warranted.