title: Peri-operative platelet function testing: the potential for reducing ischaemic and bleeding risks.
abstract: The pivotal role of platelet activation and reactivity during atherothrombotic event occurrence associated with acute coronary syndromes (ACS) or percutaneous coronary interventions (PCI) is well established. Numerous translational research studies have established a threshold level of platelet reactivity during dual antiplatelet therapy above which a higher risk for ischaemic event occurrence has been observed. The clinical validity of these threshold values in reducing ischemic event occurrence with modified P2Y12 receptor therapy is currently under investigation in large-scale clinical trials. The association between on-treatment platelet reactivity measured by an ex vivo assay and the occurrence of bleeding events is less established. Currently, there is limited evidence of an association between platelet inhibition and coronary artery bypass grafting (CABG)- related bleeding in patients on clopidogrel therapy indicating that preoperative platelet function monitoring may guide both the timing of elective CABG and the administration of blood products in patients needing surgery. However, in the absence of a large-scale prospective clinical trial, routine platelet function monitoring and modification of timing of surgery based on platelet function monitoring are currently not recommended.
authors.affiliation: Sinai Center for Thrombosis Research, 2401 W. Belvedere Ave, Baltimore, MD 21215, USA. pgurbel@lifebridgehealth.org
authors.forename: Paul A
authors.initials: PA
authors.lastname: Gurbel
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Mahla
authors.forename: Udaya S
authors.initials: US
authors.lastname: Tantry
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D006801:Humans; D007511:Ischemia / Q000517:prevention & control*; D059035:Perioperative Period; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D010979:Platelet Function Tests; D012307:Risk Factors
chemical_list: D010975:Platelet Aggregation Inhibitors