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P2Y12 Assay Identifies Patients at Risk for Blood Transfusion Following Cardiac Surgery.

Andrew D Hawkins1, Skylar C Rodgers1, Andrew M Young1

  • 1Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia.

The Journal of Surgical Research
|December 28, 2025
PubMed
Summary
This summary is machine-generated.

Preoperative P2Y12 assay results predict postoperative bleeding risk in cardiac surgery patients. A lower P2Y12 reaction unit (PRU) cutpoint more accurately identifies those needing blood transfusions.

Keywords:
Bleeding complicationsPostoperative bleedingPreoperative testing

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Area of Science:

  • Cardiology
  • Cardiothoracic Surgery
  • Pharmacology

Background:

  • Managing bleeding and ischemic risks after P2Y12 inhibitor administration in cardiac surgery is challenging.
  • Preoperative P2Y12 assay use is being explored to optimize surgical timing.

Purpose of the Study:

  • To determine if preoperative P2Y12 assay results correlate with transfusion needs, chest tube output, and reoperation for bleeding.
  • To identify a P2Y12 reaction unit (PRU) cutpoint for predicting transfusion requirements.

Main Methods:

  • Retrospective analysis of 729 cardiac surgery patients with preoperative P2Y12 assays (2012-2022).
  • Cutpoint analysis to find a PRU value associated with >1 unit of postoperative blood transfusion.
  • Risk-adjusted multivariable regression to analyze bleeding outcomes based on PRU stratification.

Main Results:

  • A median P2Y12 level of 173.0 PRU was observed in 729 patients, predominantly undergoing coronary artery bypass grafting.
  • Patients with PRU <194 showed increased postoperative hematocrit decrease and chest tube output.
  • A PRU cutpoint of 101 accurately identified patients requiring ≥1 unit of packed red blood cell (PRBC) transfusion (OR 3.2, P < 0.001).

Conclusions:

  • Preoperative P2Y12 assay is valuable for estimating postoperative bleeding risk in cardiac surgery.
  • The standard reference range cutpoint may be too conservative; a lower cutpoint (e.g., 101 PRU) better predicts the need for PRBC transfusion.