title: Individualized strategy for clopidogrel suspension in patients undergoing off-pump coronary surgery for acute coronary syndrome: a case-control study.
abstract: OBJECTIVE
  An increasing number of patients presenting for urgent coronary surgery have been exposed to clopidogrel, which constitutes a risk of bleeding and related events. Based on the wide variability in clopidogrel response and platelet function recovery after cessation, we evaluated the role of point-of-care platelet function testing to define the optimal time for off-pump coronary artery bypass graft (CABG) surgery in a case-control study.
  
  
  METHODS
  Three equally matched groups (300 patients in total) undergoing isolated off-pump CABG for acute coronary syndrome were compared. Group A were treated with clopidogrel and prospectively underwent a strategy guided by platelet function testing. Outcomes were compared with 2 propensity score matched groups: group B underwent CABG after the currently recommended 5 days without clopidogrel; group C were never exposed to clopidogrel.
  
  
  RESULTS
  Patients in group A had reduced postoperative bleeding compared with those in group B (523±202 mL vs 851±605 mL; P<.001) and a lower number of units packed red blood cells (PRBCs) transfused during the postoperative hospital stay (1.2±1.6 units vs 1.9±1.8 units; P=.004). Postoperative bleeding and the number of units of PRBCs transfused were similar in group A and group C. There was no difference in blood-derived products and platelet consumption, mortality, or the need for reoperation among the groups. Patients in group A waited 3.6±1.7 days for surgery. The strategy used for group A saved 280 days of hospital stay in total.
  
  
  CONCLUSIONS
  The strategy guided by platelet function testing for off-pump CABG offers improved guidance for optimal timing of CABG in patients treated with clopidogrel. This strategy significantly reduces postoperative bleeding and blood consumption, and has a shorter waiting time for surgery than current clinical practice.
authors: Department of Cardiac Surgery, University of Naples Federico II, Naples, Italy. Electronic address: vitomannacio2@libero.it.
authors: Vito
authors: V
authors: Mannacio
authors: Divisions of Cardiology and Cardiac Surgery, Yale Medical School, New Haven, Conn; Cardiology, University College London Hospital, London, United Kingdom.
authors: Pascal
authors: P
authors: Meier
authors: Department of Cardiology, Azienda Ospedaliera Santobono-Pausillipon, Naples, Italy.
authors: Anita
authors: A
authors: Antignano
authors: Department of Cardiac Surgery, University of Naples Federico II, Naples, Italy.
authors: Luigi
authors: L
authors: Di Tommaso
authors: Department of Cardiac Surgery, University of Naples Federico II, Naples, Italy.
authors: Vincenzo
authors: V
authors: De Amicis
authors: Department of Cardiac Surgery, University of Naples Federico II, Naples, Italy.
authors: Carlo
authors: C
authors: Vosa
mesh_terms: D054058:Acute Coronary Syndrome / Q000601:surgery*; D016022:Case-Control Studies; D000077144:Clopidogrel; D047549:Coronary Artery Bypass, Off-Pump; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D057216:Propensity Score; D011446:Prospective Studies; D012307:Risk Factors; D013535:Suspensions; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D013535:Suspensions; D000077144:Clopidogrel; D013988:Ticlopidine