title: Platelet function measurement-based strategy to reduce bleeding and waiting time in clopidogrel-treated patients undergoing coronary artery bypass graft surgery: the timing based on platelet function strategy to reduce clopidogrel-associated bleeding related to CABG (TARGET-CABG) study.
abstract: BACKGROUND
  Aspirin and clopidogrel therapy is associated with a variable bleeding risk in patients undergoing coronary artery bypass graft surgery (CABG). We evaluated the role of platelet function testing in clopidogrel-treated patients undergoing CABG.
  
  
  RESULTS
  One hundred eighty patients on background aspirin with/without clopidogrel therapy undergoing elective first time isolated on-pump CABG were enrolled in a prospective single-center, nonrandomized, unblinded investigation (Timing Based on Platelet Function Strategy to Reduce Clopidogrel-Associated Bleeding Related to CABG [TARGET-CABG] study) between September 2008 and January 2011. Clopidogrel responsiveness (ADP-induced platelet-fibrin clot strength [MA(ADP)]) was determined by thrombelastography; CABG was done within 1 day, 3-5 days, and >5 days in patients with an MA(ADP) >50 mm, 35-50 mm, and <35 mm, respectively. The primary end point was 24-hour chest tube drainage and key secondary end point was total number of transfused red blood cells. Equivalence was defined as ≤25% difference between groups. ANCOVA was used to adjust for confounders. Mean 24-hour chest tube drainage in clopidogrel-treated patients was 93% (95% confidence interval, 81-107%) of the amount observed in clopidogrel-naive patients, and the total amount of red blood cells transfused did not differ between groups (1.80 U versus 2.08 U, respectively, P=0.540). The total waiting period in clopidogrel-treated patients was 233 days (mean, 2.7 days per patient).
  
  
  CONCLUSIONS
  A strategy based on preoperative platelet function testing to determine the timing of CABG in clopidogrel-treated patients was associated with the same amount of bleeding observed in clopidogrel-naive patients and ≈50% shorter waiting time than recommended in the current guidelines.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00857155.
authors.affiliation: Sinai Center for Thrombosis Research, Baltimore, MD 21215, USA.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Mahla
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Suarez
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Bliden
authors.forename: Peter
authors.initials: P
authors.lastname: Rehak
authors.forename: Helfried
authors.initials: H
authors.lastname: Metzler
authors.forename: Alejandro J
authors.initials: AJ
authors.lastname: Sequeira
authors.forename: Peter
authors.initials: P
authors.lastname: Cho
authors.forename: Jeffery
authors.initials: J
authors.lastname: Sell
authors.forename: John
authors.initials: J
authors.lastname: Fan
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Antonino
authors.forename: Udaya S
authors.initials: US
authors.lastname: Tantry
authors.forename: Paul A
authors.initials: PA
authors.lastname: Gurbel
mesh_terms: D000368:Aged; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D015505:Chest Tubes; D000077144:Clopidogrel; D001026:Coronary Artery Bypass; D004322:Drainage / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010979:Platelet Function Tests; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D017410:Practice Guidelines as Topic; D011300:Preoperative Care; D013916:Thrombelastography; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D057832:Watchful Waiting / Q000379:methods
chemical_list: D000077144:Clopidogrel; D013988:Ticlopidine