Assessment of platelet inhibition secondary to clopidogrel and aspirin therapy in preoperative acute surgical patients measured by Thrombelastography® Platelet Mapping™

被引:84
作者
Collyer, T. C. [1 ]
Gray, D. J. [2 ]
Sandhu, R. [2 ]
Berridge, J. [3 ]
Lyons, G. [2 ]
机构
[1] Royal Perth Hosp, Acad Unit Anaesthesia, Perth, WA, Australia
[2] St James Univ Hosp, Dept Anaesthesia, Leeds, W Yorkshire, England
[3] Leeds Gen Infirm, Dept Anaesthesia, Leeds, W Yorkshire, England
关键词
blood; anticoagulation; aspirin; coagulation; platelets; measurement techniques; Thrombelastograph (TM); ANTIPLATELET THERAPY; AGGREGATION; STRESS; PRETREATMENT; VARIABILITY; BLOCKADE; SURGERY;
D O I
10.1093/bja/aep039
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Increasing numbers of patients prescribed clopidogrel and aspirin are presenting for non-elective surgery. No consensus on the timing of surgery exists after withdrawal of antiplatelet and tests of platelet function are not routinely available. The Thrombelastography (R) Platelet Mapping (TM) (TEG-PM) assay is designed to assess platelet inhibition secondary to antiplatelet therapy. We assessed its ability to detect platelet inhibition in preoperative acute surgical patients. We conducted a prospective observational study in three groups of preoperative patients: those taking clopidogrel or aspirin up to admission, and a control group. TEG-PM was performed on the day of admission and alternate days until surgery. Mean (sd) platelet thromboxane A(2) receptor inhibition in the control group was 17.5% (23.8) (n=20), 52.6% (32.3) (n=18) in the aspirin group, and 31.9% (27.6) (n=21) in the clopidogrel group (P < 0.01). Mean (sd) platelet adenosine diphosphate (ADP) receptor inhibition in the control group was 47.8% (18.9) (n=20), 52.6% (19.7) (n=18) in the aspirin group, and 71.5% (18.4) (n=21) in the clopidogrel group (P < 0.01). Among the clopidogrel group awaiting surgery, mean platelet ADP channel inhibition decreased on day 3 to 67.1% (24.7) (n=11), 48.8% (24.4) (n=4) on day 5, and 36.1% (15.9) (n=2) on day 7 (P=0.57). TEG-PM can identify statistically significant platelet inhibition after antiplatelet therapy; however, the overlap in platelet receptor inhibition between the three groups is likely to limit the clinical usefulness of this test.
引用
收藏
页码:492 / 498
页数:7
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