Effect of preoperative P2Y12 and thrombin platelet receptor inhibition on bleeding after cardiac surgery.

Platelet P2Y12 receptor inhibitors (thienopyridine derivatives such as clopidogrel, prasugrel and ticagrelor) are widely used in patients with cardiovascular disease. It is not completely clear whether the preoperative and continued use of these antiplatelet agents is associated with increased perioperative blood loss in patients undergoing cardiac surgery.

In this study, preoperative residual platelet function was assessed by multiplate aggregometry of platelet P2Y12 receptor activity (ADP test) and protease-activated receptor (PAR) reactivity with a thrombin-receptor activating peptide (TRAP test) in patients who were scheduled for cardiac surgery. The authors found that there was a significant correlation between the results of these tests and postoperative (severe) bleeding. In particular, the negative predictive values for (severe) perioperative bleeding complications was low when both tests were normal. The positive predictive value of an abnormal test result for haemorrhagic complications was relatively low.

This is an important study showing that laboratory tools can be helpful in identifying patients treated with thienopyridine derivatives who can safely undergo cardiac surgery. A practical disadvantage may be that these tests are not widely available in routine settings.

– Marcel Levi

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