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Does thromboelastography predict bleeding in patients treated with clopidogrel or ticagrelor in off-pump coronary

Zi Wang1, Ye Zou1, Limin Xia2

  • 1Department of Pharmacy, Zhongshan Hospital, Fudan University, China.

Thrombosis Research
|April 2, 2022
PubMed

Insights

Platelet function testing can predict excessive blood loss after off-pump coronary artery bypass grafting (OPCABG) but not major bleeding complications. Discontinuation time of P2Y12 receptor antagonists is linked to major bleeding risk.

Area of Science:

  • Cardiology
  • Hematology
  • Surgical Research

Background:

  • Antiplatelet therapy with clopidogrel or ticagrelor is common in patients undergoing off-pump coronary artery bypass grafting (OPCABG).
  • Assessing platelet function may help predict bleeding risk in these patients.

Purpose of the Study:

  • To evaluate the predictive value of platelet function tests for bleeding complications in patients treated with clopidogrel or ticagrelor undergoing OPCABG.

Main Methods:

  • Prospective study of 434 patients on aspirin plus clopidogrel or ticagrelor undergoing OPCABG.
  • Platelet aggregation assessed by thromboelastography.
  • Excessive blood loss defined as >600 mL chest tube drainage at 12 hours postoperatively; major bleeding defined by BARC type 4 or UDPB class 3/4.

Main Results:

  • A negative correlation was found between ADP-induced platelet aggregation and 12-hour chest tube drainage (r = -0.133, P = 0.0056).
  • ADP-induced platelet aggregation <33.45% independently predicted excessive postoperative blood loss (OR = 2.976, P = 0.008).
  • Platelet function assessment did not predict major bleeding (UDPB or BARC defined); P2Y12 antagonist discontinuation time was independently associated with major bleeding.

Conclusions:

  • Thromboelastography-based ADP-induced platelet aggregation is negatively related to postoperative blood loss and predicts excessive bleeding after OPCABG.
  • Platelet function assessment using thromboelastography is insufficient for predicting major bleeding complications in this patient group.
  • Discontinuation of P2Y12 receptor antagonists is a significant independent predictor of major bleeding complications following OPCABG.
Abstract

Keywords:
BleedingOPCABGPlatelet functionThromboelastography

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