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Platelet function recovery after ticagrelor withdrawal in patients awaiting urgent coronary surgery

Artikel i vetenskaplig tidskrift
Författare Emma C. Hansson
Carl Johan Malm
Camilla Hesse
Björn Hornestam
Mikael Dellborg
Helena Rexius
Anders Jeppsson
Publicerad i European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
Volym 51
Nummer/häfte 4
Sidor 633-637
ISSN 1010-7940
Publiceringsår 2017
Publicerad vid Institutionen för medicin, avdelningen för molekylär och klinisk medicin
Sidor 633-637
Språk en
Länkar doi.org/10.1093/ejcts/ezw373
Ämneskategorier Klinisk medicin

Sammanfattning

OBJECTIVE: Dual antiplatelet therapy with ticagrelor and aspirin is associated with an increased risk of perioperative bleeding complications. Current guidelines recommend therefore discontinuation of ticagrelor 5 days before surgery to allow sufficient recovery of platelet function. It is not known how the time to recovery varies between individual patients after discontinuation of ticagrelor. METHODS: Twenty-five patients accepted for urgent coronary artery bypass surgery and treated with ticagrelor and aspirin were included in a prospective observational study. Platelet aggregation was evaluated with impedance aggregometry at five timepoints 12-96 h after discontinuation of ticagrelor. In a subset of patients (n = 15), we also tested the ex vivo efficacy of platelet concentrate supplementation on platelet aggregation. RESULTS: There was a gradual increase in mean adenosine diphosphate-induced platelet aggregation after discontinuation of ticagrelor. After 72 h, mean aggregation was 38 +/-23 aggregation units (U), which is above a previously suggested cut-off of 22 U, when patients can be operated without increased bleeding risk. However, there was a large interindividual variability (range 488 U at 72 h) and 6/24 patients (25%) had <22 U after 72 h. Ex vivo administration of platelet concentrate did not improve adenosine diphosphate-induced aggregation at any timepoint after ticagrelor discontinuation. CONCLUSIONS: Adenosine diphosphate-induced aggregation was acceptable after 72 h in the majority of patients but with a large interindividual variability. Due to the large variability, platelet function testing may prove to be a valuable tool in timing of surgery in patients with ongoing or recently stopped ticagrelor treatment. Adenosine diphosphate-induced aggregation was not improved by addition of platelet concentrate.

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