Platelet function testing to time surgery in patients on dual antiplatelet therapy?
In patients pretreated with P2Y12 receptor inhibitors who need to undergo non-emergent cardiac or major non-cardiac surgery, current guidelines of the European Society of Cardiology recommend postponing surgery for at least five days after last intake of clopidogrel or ticagrelor, and for seven days after last intake of prasugrel, unless there is high risk of ischemic events. However, a fixed five to seven days preoperative waiting period may be challenged, in the presence of inter-individual variability in on-treatment platelet reactivity. Therefore, Society of Thoracic Surgeons guidelines suggest to base decisions about a surgical delay on platelet function although both, the optimal platelet function assay and a bleeding cutoff have not yet been defined by large scale multicenter trials. This review aims to provide an overview on current knowledge of P2Y12 receptor induced platelet inhibition and surgery related bleeding and the potential role of platelet function analysis to time surgery.
Elisabeth Mahla, M.D., Department of Anesthesiology and Intensive Care, Medicine, Research Unit for Perioperative Platelet, Function, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria, Tel. +43/316/38 51 30 27, Fax +43/316/38 51 32 67, E-mail: elisabeth.mahla@medunigraz.at.
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Toller
D016063:Blood Loss, Surgical / Q000517:prevention & control*; D004359:Drug Therapy, Combination / Q000009:adverse effects; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D010979:Platelet Function Tests / Q000379:methods*; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000517:prevention & control*; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D028761:Withholding Treatment
D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists
P2Y12 receptor inhibitors; platelet function testing; preoperative; surgery