title: Platelet activity measured by a rapid turnaround assay identifies coronary artery bypass grafting patients at increased risk for bleeding and transfusion complications after clopidogrel administration.
abstract: BACKGROUND
  We sought to establish a metric for easily estimating bleeding and transfusion risks for cardiac surgery patients after antiplatelet agent use.
  
  
  METHODS
  Deidentified records of patients who underwent coronary artery bypass grafting (CABG) at our institution (January 2010-June 2011) were searched for patients without identified risk factors for excessive bleeding who underwent documented P2Y12 testing after clopidogrel administration (n = 276). Clinical outcomes were analyzed according to whether preoperative platelet function was higher (platelet reactivity units [PRUs], ≥237) or lower (PRU, <237) and according to preoperative PRU cutoffs: high (>290, or no clopidogrel), intermediate (200-290), or low (<200).
  
  
  RESULTS
  Eighty-five patients (57%) received allogeneic blood products at 24 hours or less postoperatively: 33 (22%) received fresh frozen plasma, and 57 (38%) received platelets. The median 12-hour chest tube output (CTO) was 350 mL (interquartile range, 260-490 mL); CTO was "high" (>437 mL) in 62 (42%) of the clopidogrel-treated patients. Lower-PRU patients were more likely to receive coagulation factors (odds ratio [OR], 2.82; P = .0004) and to have high CTO or coagulation factor transfusion (OR, 2.35; P = .02) than higher-PRU patients. Likewise, intermediate- and low-PRU patients had incrementally greater incidences of high CTO (OR, 1.72; P = .002) and coagulation factor transfusion (OR, 2.08; P < .0001) than high-PRU/no clopidogrel patients. High CTO or coagulation factor transfusion was more frequent in intermediate-PRU (OR, 2.67; P = .02) and low-PRU (OR, 5.08; P = .0002) patients than in high-PRU/no clopidogrel patients.
  
  
  CONCLUSIONS
  Among clopidogrel-treated CABG patients, preoperative platelet function testing can identify those at increased risk for postoperative bleeding and transfusion.
authors: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute at St Luke's Episcopal Hospital, Houston, Tex. Electronic address: todd.rosengart@bcm.edu.
authors: Todd K
authors: TK
authors: Rosengart
authors: Jamie L
authors: JL
authors: Romeiser
authors: Lauren J
authors: LJ
authors: White
authors: Ashley
authors: A
authors: Fratello
authors: Eleanor
authors: E
authors: Fallon
authors: Lisa
authors: L
authors: Senzel
authors: Annie Laurie
authors: AL
authors: Shroyer
mesh_terms: D000368:Aged; D001792:Blood Platelets / Q000187:drug effects* / Q000378:metabolism; D016009:Chi-Square Distribution; D000077144:Clopidogrel; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D010979:Platelet Function Tests; D019106:Postoperative Hemorrhage / Q000097:blood / Q000139:chemically induced* / Q000628:therapy*; D011237:Predictive Value of Tests; D011300:Preoperative Care; D058921:Purinergic P2Y Receptor Antagonists / Q000009:adverse effects*; D058925:Receptors, Purinergic P2Y12 / Q000097:blood / Q000187:drug effects; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives*; D013997:Time Factors; D065227:Transfusion Reaction; D016896:Treatment Outcome
chemical_list: C548576:P2RY12 protein, human; D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D058925:Receptors, Purinergic P2Y12; D000077144:Clopidogrel; D013988:Ticlopidine
keywords: 13; 23.1; 24; 54; ACCF; AHA; American College of Cardiology Foundation; American Heart Association; BSA; CABG; CI; CTO; IQR; OR; PCI; PRU; QA; SBU; SQDUG; SQIP; STS; Society of Thoracic Surgeons; Stony Brook University; Surgical Quality Data Users Group; Surgical Quality Improvement Program; body surface area; chest tube output; confidence interval; coronary artery bypass grafting; interquartile range; odds ratio; percutaneous coronary intervention; platelet reactivity units; quality assurance