scholarly journals The Use of Point-of-care Testing in Detecting Platelet Function Recovery in a Patient Treated with Prasugrel Undergoing Urgent Surgical Revascularization

2021 ◽  
Author(s):  
Alessandra Verzelloni Sef ◽  
Francesca Caliandro ◽  
Davorin Sef ◽  
Shahzad Raja
Keyword(s):  
Platelet Function ◽  
Waiting Time ◽  
Point Of Care ◽  
Artery Bypass ◽  
Postoperative Bleeding ◽  
Platelet Function Testing ◽  
Increased Risk ◽  
Function Recovery ◽  
Patients At Risk ◽  
Function Testing

A recent administration of potent P2Y12 receptor inhibitor such as prasugrel in patients undergoing cardiac surgery remains a dilemma and little is known about its impact on platelet function recovery. Guidelines recommend discontinuation of prasugrel 7 days before surgery to reduce the risk of surgery-related bleeding. Patients at risk may benefit from preoperative platelet function testing to guide individualized preoperative waiting time. We present a rare case of complete function recovery in a patient treated with prasugrel revealed by preoperative platelet function monitoring before urgent coronary artery bypass surgery (CABG). A complete platelet function recovery was revealed by platelet function testing after discontinuation of prasugrel for four days and patient underwent urgent CABG without increased risk of postoperative bleeding. Our case with a review of literature emphasized that the decision to proceed with urgent CABG in a patient recently treated with prasugrel should be based on a personalized risk assessment and might be supported by preoperative platelet function monitoring to shorten the waiting time.

Individualised Antiplatelet Therapy – Is There a Role for Platelet Function Testing in Routine Clinical Practice?

2010 ◽  
Vol 5 (1) ◽  
pp. 96 ◽  
Author(s):  
Collet Jean-Philippe ◽  
Jochem Wouter van Werkum ◽  
◽  
Keyword(s):  
Clinical Practice ◽  
Antiplatelet Therapy ◽  
Platelet Function ◽  
Platelet Reactivity ◽  
Point Of Care ◽  
Coronary Intervention ◽  
Platelet Function Testing ◽  
Increased Risk ◽  
Coronary Syndromes ◽  
Function Testing

Antiplatelet therapies are often used to minimise complications in patients with acute coronary syndromes or who are undergoing percutaneous coronary intervention with stenting. However, the occurrence of ‘high on-treatment platelet reactivity’ associated with the gold standard treatments aspirin and clopidogrel in a subset of individuals limits the efficacy of these drugs. This lack of response, which has been attributed to a genetic polymorphism, is associated with an increased risk of subsequent atherothrombotic events. In recent years, platelet function assays have been used to monitor antiplatelet inhibition. Various tests have been introduced that allow physicians to evaluate pharmacological response and potentially permit risk stratification of patients. While some of these assays have proved to be labour-intensive, the development of point-of-care assays may ease the time burden in clinical practice. Preliminary findings demonstrate the effectiveness of altering therapy based on assay results in terms of improving clinical outcomes, suggesting an important role for platelet function testing in the future of antiplatelet therapy.

Individualised Antiplatelet Therapy – Is There a Role for Platelet Function Testing in Routine Clinical Practice?

2010 ◽  
Vol 6 (1) ◽  
pp. 41 ◽  
Author(s):  
Collet Jean-Philippe ◽  
Jochem Wouter van Werkum ◽  
◽  
Keyword(s):  
Clinical Practice ◽  
Antiplatelet Therapy ◽  
Platelet Function ◽  
Platelet Reactivity ◽  
Point Of Care ◽  
Coronary Intervention ◽  
Platelet Function Testing ◽  
Increased Risk ◽  
Coronary Syndromes ◽  
Function Testing

Antiplatelet therapies are often used to minimise complications in patients with acute coronary syndromes or who are undergoing percutaneous coronary intervention with stenting. However, the occurrence of ‘high on-treatment platelet reactivity’ associated with the gold standard treatments aspirin and clopidogrel in a subset of individuals limits the efficacy of these drugs. This lack of response, which has been attributed to a genetic polymorphism, is associated with an increased risk of subsequent atherothrombotic events. In recent years, platelet function assays have been used to monitor antiplatelet inhibition. Various tests have been introduced that allow physicians to evaluate pharmacological response and potentially permit risk stratification of patients. While some of these assays have proved to be labour-intensive, the development of point-of-care assays may ease the time burden in clinical practice. Preliminary findings demonstrate the effectiveness of altering therapy based on assay results in terms of improving clinical outcomes, suggesting an important role for platelet function testing in the future of antiplatelet therapy.

scholarly journals Platelet Function Testing for Cardiac Surgery Patients on Antiplatelet Therapy: The Extreme Variability of Point-Of-Care Tests

2018 ◽  
Vol 11 (2) ◽  
pp. 593-607
Author(s):  
Beatrice O. Ondondo
Keyword(s):  
Cardiac Surgery ◽  
Antiplatelet Therapy ◽  
Platelet Function ◽  
Point Of Care ◽  
Cardiac Patients ◽  
Platelet Function Testing ◽  
Increased Risk ◽  
Extreme Variability ◽  
Point Of Care Tests ◽  
Function Testing

Platelets play a pivotal role in coagulation, and both quantitative and qualitative platelet defects can lead to major bleeding during and after surgery. Moreover, patients with cardiac disease are often on antiplatelet therapies as part of routine management, which predisposes to increased risk of perioperative bleeding due to inhibited platelet function. In some cases, antiplatelet therapy is interrupted briefly before scheduled cardiac surgery in order to reduce the risk of haemorrhage; however, this can increase the risk of perioperative thrombosis if not monitored carefully. Furthermore, individual patients respond differently to antiplatelet therapy. Therefore, point-of-care tests that determine platelet function could provide improved, personalised evidence-based treatment and management of such high-risk cardiac patients. This article reviewed various methods and devices used for testing platelet function at point-of-care in cardiac patients on antiplatelet therapy who were undergoing cardiac surgery. The consensus is that point-of-care testing of platelet function can offer three main advantages for the timely management of preoperative and perioperative coagulation in cardiac surgery patients who are on antiplatelet therapy: 1.) Assessing the effectiveness of antiplatelet therapy to quickly identify patients with resistance, who have increased risk of pre- and perioperative thrombotic events. 2.) Assessing platelet function recovery following treatment withdrawal to determine optimal timings for cardiac surgery, in order to avoid excessive haemorrhage, and reduce waiting times and hospitalisation costs for patients scheduled for cardiac surgery. 3.) Efficient use of transfusion blood products. However, an important finding of this review is that there exists extreme variability and a lack of correlation among the various point-of-care platelet function testing assays. Furthermore, the assays show inconsistencies in predicting blood loss, or adverse thrombotic and haemorrhagic events in cardiac patients on antiplatelet therapy and those undergoing surgery. It is imperative that point-of-care platelet function tests accurately predict the risks of bleeding and thrombosis in order to be clinically relevant in the preoperative, perioperative and long-term post-operative care and management of cardiac surgery patients on antiplatelet therapy. The extreme variability of these tests, coupled with inconsistencies in predicting adverse events do not support the high costs of large-scale implementation.

Point-of-care platelet function testing to predict blood loss after coronary artery bypass grafting surgery: a prospective observational pilot study

Perfusion ◽  
2016 ◽  
Vol 31 (8) ◽  
pp. 676-682 ◽  
Author(s):  
James Ellis ◽  
Oswaldo Valencia ◽  
Agnieszka Crerar-Gilbert ◽  
Simon Phillips ◽  
Hanif Meeran ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Pilot Study ◽  
Blood Loss ◽  
Coronary Artery Bypass ◽  
Platelet Function ◽  
Point Of Care ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Function Testing

Platelet function testing and prediction of procedural bleeding risk

2013 ◽  
Vol 109 (05) ◽  
pp. 817-824 ◽  
Author(s):  
Erik L. Grove ◽  
Rashed Hossain ◽  
Robert F. Storey
Keyword(s):  
Platelet Function ◽  
Best Practice ◽  
Artery Bypass ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Antiplatelet Drugs ◽  
Loss Of Function ◽  
Platelet Function Testing ◽  
P2y12 Inhibitors ◽  
Function Testing

SummaryThe essential role of platelets in haemostasis underlies the relationship between platelet function and spontaneous or procedure-related bleeding, which has important prognostic implications. Although not routinely undertaken, platelet function testing offers the potential to tailor antiplatelet therapy for individual patients. However, uncertainties remain about how well platelet function testing may predict haemostasis and guide management of bleeding risk. Studies of aspirin, P2Y12 inhibitors and other antiplatelet drugs clearly demonstrate how inhibition of platelet function increases bleeding risk. More potent antiplatelet drugs are associated with higher bleeding rates, consistent with the levels of platelet inhibition achieved by these drugs. Studies of patients treated with clopidogrel, which is associated with wide inter-individual variation in antiplatelet effect, suggest that platelet function testing may predict bleeding risk related to coronary artery bypass grafting (CABG) surgery and potentially guide the timing of surgery following discontinuation of clopidogrel. Similarly, some studies have demonstrated a relationship between clopidogrel response and bleeding in patients undergoing percutaneous coronary intervention (PCI), although other studies have not supported this. Carriage of the *17 allele of cytochrome P450 2C19, which is associated with gain of function and enhanced response to clopidogrel, seems to be associated with increased bleeding risk, although studies showing lack of apparent effect of loss-of-function alleles provide contradictory evidence. Further large studies are needed to guide best practice in the application of platelet function testing in the clinical management of patients treated with antiplatelet drugs in order to optimise individual care.

scholarly journals Point-of-Care Platelet Function Testing in Cardiac Surgery: A Bundle of Measures Create Adequate Hemostatic Algorithm

2015 ◽  
Vol 29 (5) ◽  
pp. e53-e54 ◽  
Author(s):  
Mate Petricevic ◽  
Martina Zrno Mihaljevic ◽  
Marko Boban ◽  
Alexandra White ◽  
Bojan Biocina
Keyword(s):  
Cardiac Surgery ◽  
Platelet Function ◽  
Point Of Care ◽  
Platelet Function Testing ◽  
Function Testing

The surgical application of point-of-care haemostasis and platelet function testing

2008 ◽  
Vol 95 (11) ◽  
pp. 1317-1330 ◽  
Author(s):  
K. J. Dickinson ◽  
M. Troxler ◽  
S. Homer-Vanniasinkam
Keyword(s):  
Platelet Function ◽  
Point Of Care ◽  
Platelet Function Testing ◽  
Surgical Application ◽  
Function Testing
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