title: Single vs double antiplatelet therapy in acute coronary syndrome: Predictors of bleeding after coronary artery bypass grafting.
abstract: OBJECTIVE
  To investigate the contribution of anti-platelet therapy and derangements of pre-operative classical coagulation and thromboelastometry parameters to major bleeding post-coronary artery bypass grafting (CABG).
  
  
  METHODS
  Two groups of CABG patients were studied: Group A, treated with aspirin alone (n = 50), and Group B treated with aspirin and clopidogrel (n = 50). Both had similar preoperative, clinical, biologic characteristics and operative management. Classic coagulation parameters and rotational thromboelastometry (ROTEM) profiles were determined preoperatively for both groups and the same heparin treatment was administered. ROTEM profiles (INTEM and EXTEM assays) were analyzed, both for traditional parameters, and thrombin generation potential, expressed by area-under-curve (AUC).
  
  
  RESULTS
  There was no significant difference between rates of major bleeding between patients treated with aspirin alone, compared with those treated with aspirin and clopidogrel (12% vs 16%, P = 0.77). In the 14 cases of major bleeding, pre-operative classic coagulation and traditional ROTEM parameters were comparable. Conversely we observed that the AUC in the EXTEM test was significantly lower in bleeders (5030 ± 1115 Ohm*min) than non-bleeders (6568 ± 548 Ohm*min) (P < 0.0001).
  
  
  CONCLUSIONS
  We observed that patients with a low AUC value were at a significantly higher risk of bleeding compared to patients with higher AUC, regardless of antiplatelet treatment. This suggests that thrombin generation potential, irrespective of the degree of platelet inhibition, correlates with surgical bleeding.
authors.affiliation: Vincenzo Tarzia, Giacomo Bortolussi, Edward Buratto, Giulio Rizzoli, Tomaso Bottio, Gino Gerosa, Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, 35128 Padua, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Tarzia
authors.affiliation: Vincenzo Tarzia, Giacomo Bortolussi, Edward Buratto, Giulio Rizzoli, Tomaso Bottio, Gino Gerosa, Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, 35128 Padua, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Bortolussi
authors.affiliation: Vincenzo Tarzia, Giacomo Bortolussi, Edward Buratto, Giulio Rizzoli, Tomaso Bottio, Gino Gerosa, Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, 35128 Padua, Italy.
authors.forename: Edward
authors.initials: E
authors.lastname: Buratto
authors.affiliation: Vincenzo Tarzia, Giacomo Bortolussi, Edward Buratto, Giulio Rizzoli, Tomaso Bottio, Gino Gerosa, Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, 35128 Padua, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Paolini
authors.affiliation: Vincenzo Tarzia, Giacomo Bortolussi, Edward Buratto, Giulio Rizzoli, Tomaso Bottio, Gino Gerosa, Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, 35128 Padua, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Dal Lin
authors.affiliation: Vincenzo Tarzia, Giacomo Bortolussi, Edward Buratto, Giulio Rizzoli, Tomaso Bottio, Gino Gerosa, Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, 35128 Padua, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Rizzoli
authors.affiliation: Vincenzo Tarzia, Giacomo Bortolussi, Edward Buratto, Giulio Rizzoli, Tomaso Bottio, Gino Gerosa, Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, 35128 Padua, Italy.
authors.forename: Tomaso
authors.initials: T
authors.lastname: Bottio
authors.affiliation: Vincenzo Tarzia, Giacomo Bortolussi, Edward Buratto, Giulio Rizzoli, Tomaso Bottio, Gino Gerosa, Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, 35128 Padua, Italy.
authors.forename: Gino
authors.initials: G
authors.lastname: Gerosa
keywords: Acute coronary syndrome; Bleeding; Coronary artery bypass grafting; Platelet inhibitors; Thromboelastometry