Postoperative platelet function is associated with severe bleeding in ticagrelor-treated patients.

Area of Science:

• Cardiovascular Medicine
• Hematology
• Surgical Research

Background:

• Preoperative platelet function testing is established for predicting bleeding risk in cardiac surgery patients on dual antiplatelet therapy.
• The utility of postoperative platelet function testing, considering both pre- and perioperative influences, has not been previously evaluated.

Purpose of the Study:

• To evaluate the association between postoperative platelet function and severe bleeding in cardiac surgery patients.
• To compare the predictive value of postoperative versus preoperative platelet function testing for bleeding risk.

Main Methods:

• A prospective observational study included 74 patients with acute coronary syndrome treated with aspirin and ticagrelor before cardiac surgery.
• Platelet aggregation was measured using multiple electrode impedance aggregometry before surgery and 2 hours after cardiopulmonary bypass.
• Receiver operating characteristic curves analyzed the association between platelet aggregation and severe bleeding.

Main Results:

• Severe bleeding occurred in 34% of patients. Both preoperative and postoperative adenosine diphosphate-induced platelet aggregation showed comparable predictive accuracy for bleeding (AUC ~0.75-0.77).
• Postoperative aggregation induced by arachidonic acid and thrombin receptor-activating peptide had lower predictive value.
• Significant correlations were found between pre- and postoperative platelet aggregation, but with substantial interindividual variability.

Conclusions:

• Postoperative platelet function testing is a viable predictor of severe bleeding, with accuracy comparable to preoperative testing.
• While a correlation exists between pre- and postoperative platelet function, its predictability for individual patients is limited.