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Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
Assessment of platelet function after discontinuation of ticagrelor
Martin Söderberg1, Manne Holm1, Anil Gupta1
1Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
Insights
Discontinuing ticagrelor for 3 days before surgery restores adequate platelet function in most patients, reducing bleeding risk. Bedside platelet function tests can guide decisions when surgery is less than 5 days post-discontinuation.
Area of Science:
- Cardiology
- Hematology
- Pharmacology
Background:
- Patients with acute coronary syndromes (ACS) often undergo percutaneous coronary intervention (PCI) and receive dual antiplatelet therapy (DAPT), typically aspirin and a P2Y12 inhibitor like ticagrelor.
- Determining the optimal timing for DAPT discontinuation before interventional surgery is a critical clinical question.
Purpose of the Study:
- To investigate platelet function immediately before and after discontinuing ticagrelor in patients undergoing urgent surgery.
- To assess the return of adequate platelet function to minimize perioperative bleeding risk.
Main Methods:
- A prospective, longitudinal, observational study involving 24 patients.
- Venous blood samples were collected on days 0, 1, 3, 5, and 8 after ticagrelor discontinuation.
- Platelet function was analyzed using Multiplate® and VerifyNow® assays.
Main Results:
- On day 3 post-discontinuation, 100% of patients achieved adequate platelet function on Multiplate® and 67% on VerifyNow®, correlating with reduced bleeding risk.
- By day 5, 100% achieved adequate function on Multiplate® and 78% on VerifyNow®.
- These results indicate a significant return of platelet function within 3-5 days of ticagrelor cessation.
Conclusions:
- Discontinuing ticagrelor for 3 days leads to adequate platelet function in all patients (Multiplate®) and a majority (VerifyNow®), suggesting a lower bleeding risk.
- Consideration of bedside platelet function testing is recommended if surgery is anticipated within 5 days of ticagrelor discontinuation.
Background:
Patients presenting with acute coronary syndromes (ACS) are often treated by percutaneous coronary intervention (PCI) with insertion of coronary artery stents and a majority receive dual antiplatelet therapy (DAPT), usually a combination of a COX-1 inhibitor (aspirin) and a P2Y12 inhibitor (eg ticagrelor). Not seldom the question arises as to when DAPT should be discontinued prior to interventional surgery. This study was done with the primary aim of investigating thrombocyte function immediately prior to and after discontinuation of ticagrelor.
Materials And Methods:
In this prospective, longitudinal, observational study including 24 patients, venous blood was obtained from patients on day 0, before stopping maintenance dose of 90 mg ticagrelor twice daily, and then on days 1, 3, 5, and 8, after discontinuation. Samples were analyzed using Multiplate® and VerifyNow® .
Results:
Prior to urgent surgery platelet aggregation >30 aggregation units (Multiplate® ) and >208 P2Y12 reaction units (VerifyNow® ) have been shown to correlate with reduced risk of peri- and postoperative bleeding risk. On day 3 after ticagrelor discontinuation, 100% (P = .016) and 67% (P=<.001) of patients had reached these levels on Multiplate® and VerifyNow® , respectively. On day 5, the corresponding figures were 100% (P = .016) and 78% (P=<.001).
Conclusion:
Discontinuation of ticagrelor for 3 days resulted in return of adequate platelet function in all patients on Multiplate® and in a majority of patients on VerifyNow® , indicating a lower bleeding risk. A bedside test for platelet function may be considered if time to anticipated surgery is less than 5 days after ticagrelor discontinuation.
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