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Open AccessArticle

Reduction of Preoperative Waiting Time Before Urgent Surgery for Patients on P2Y12 Inhibitors Using Multiple Electrode Aggregometry: A Retrospective Study

1
Haematology Laboratory, NAmur Research Institute for LIfe Sciences (NARILIS), Namur Thrombosis and Hemostasis Center (NTHC), Université catholique de Louvain, CHU UCL Namur, 5530 Yvoir, Belgium
2
Department of Anesthesiology, NAmur Research Institute for LIfe Sciences (NARILIS), Namur Thrombosis and Hemostasis Center (NTHC), Université catholique de Louvain, CHU UCL Namur, 5530 Yvoir, Belgium
3
Departments of Medicine, University Hospitals of Geneva, and GpG-Faculty of Medicine Geneva University, 14 CH-1211 Geneva, Switzerland
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
J. Clin. Med. 2020, 9(2), 424; https://doi.org/10.3390/jcm9020424
Received: 2 January 2020 / Revised: 30 January 2020 / Accepted: 31 January 2020 / Published: 4 February 2020
P2Y12 inhibitor discontinuation is essential before most surgical interventions to limit bleeding complications. Based on pharmacodynamic data, fixed discontinuation durations have been recommended. However, as platelet function recovery is highly variable among patients, a more individualized approach based on platelet function testing (PFT) has been proposed. The aim of this retrospective single-centre study was to determine whether PFT using whole blood adenosine diphosphate–multiple electrode aggregometry (ADP–MEA) was associated with a safe reduction of preoperative waiting time. Preoperative ADP–MEA was performed for 29 patients on P2Y12 inhibitors. Among those, 17 patients underwent a coronary artery bypass graft. Twenty one were operated with an ADP–MEA ≥ 19 U (quantification of the area under the aggregation curve), and the waiting time was shorter by 1.6 days (median 1.8 days, IQR 0.5–2.9), by comparison with the current recommendations (five days for clopidogrel and ticagrelor, seven days for prasugrel). Platelet function recovery was indeed highly variable among individuals. With the 19 U threshold, high residual platelet inhibition was associated with perioperative platelet transfusion. These results suggest that preoperative PFT with ADP–MEA could help reduce waiting time before urgent surgery for patients on P2Y12 inhibitors. View Full-Text
Keywords: multiple electrode aggregometry; multiplate; P2Y12 inhibitors; clopidogrel; prasugrel; ticagrelor; preoperative; perioperative; urgent surgery multiple electrode aggregometry; multiplate; P2Y12 inhibitors; clopidogrel; prasugrel; ticagrelor; preoperative; perioperative; urgent surgery
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Hardy, M.; Dupuis, C.; Dincq, A.-S.; Jacqmin, H.; Lecompte, T.; Mullier, F.; Lessire, S. Reduction of Preoperative Waiting Time Before Urgent Surgery for Patients on P2Y12 Inhibitors Using Multiple Electrode Aggregometry: A Retrospective Study. J. Clin. Med. 2020, 9, 424.

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