Thienopyridines resistance and recovery of platelet function after discontinuation of thienopyridines in cardiac surgery patients

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Abstract

OBJECTIVES: Patients who undergo cardiac operations under the effects of thienopyridines have a greater risk of major postoperative bleeding, transfusions and surgical revision due to bleeding. Discontinuation of thienopyridine is suggested but an adequate recovery period following discontinuation is still under debate, with opinions ranging from 3 to 7 days. The aim of this study was to assess the rate of recovery of thienopyridine-resistant patients and the time taken for resumption of platelet function after discontinuation of thienopyridine, in the setting of patients scheduled for cardiac operations. METHODS: This was a retrospective study, based on 344 patients screened for platelet aggregation before cardiac operations. All the patients received thienopyridines within 7 days prior to the test. Multiple electrode aggregometry 0adenosine diphosphate test was used to assess platelet aggregation before the operation. RESULTS: Thienopyridine resistance rate was 28%. Patients receiving clopidogrel had a significantly higher rate (32%) of resistance, compared with those receiving ticlopidine (14%) and thienopyridine resistance was significantly associated with platelet count (P = 0.006). The time taken to recover platelet function after thienopyridine discontinuation was variable between individuals; the only factor associated with a faster recovery time was the serum bilirubin value (P = 0.002). Platelet aggregation values high enough to avoid major bleeding were reached 3 days after discontinuation (95% confidence interval: 2-4 days); however, a complete recovery of platelet function was reached only after 8 days (95% confidence interval: 7-9 days). CONCLUSIONS: Patient-specific factors determine the effectiveness of thienopyridine treatment and platelet function recovery rate. Among these, platelet count (for thienopyridine resistance) and serum bilirubin values (for platelet function recovery rate) should be considered.

Original languageEnglish
Article numberezt279
Pages (from-to)165-170
Number of pages6
JournalEuropean Journal of Cardio-thoracic Surgery
Volume45
Issue number1
DOIs
Publication statusPublished - Jan 2014

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Thienopyridines
Recovery of Function
Thoracic Surgery
Blood Platelets
Platelet Aggregation
clopidogrel
Hemorrhage
Platelet Count
Bilirubin
Confidence Intervals
Ticlopidine
thienopyridine
Diphosphates
Serum
Reoperation
Electrodes
Retrospective Studies

Keywords

  • Bleeding
  • Coronary artery bypass surgery
  • Platelets

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

@article{41e4f434a75a4111b203c64e4967334d,
title = "Thienopyridines resistance and recovery of platelet function after discontinuation of thienopyridines in cardiac surgery patients",
abstract = "OBJECTIVES: Patients who undergo cardiac operations under the effects of thienopyridines have a greater risk of major postoperative bleeding, transfusions and surgical revision due to bleeding. Discontinuation of thienopyridine is suggested but an adequate recovery period following discontinuation is still under debate, with opinions ranging from 3 to 7 days. The aim of this study was to assess the rate of recovery of thienopyridine-resistant patients and the time taken for resumption of platelet function after discontinuation of thienopyridine, in the setting of patients scheduled for cardiac operations. METHODS: This was a retrospective study, based on 344 patients screened for platelet aggregation before cardiac operations. All the patients received thienopyridines within 7 days prior to the test. Multiple electrode aggregometry 0adenosine diphosphate test was used to assess platelet aggregation before the operation. RESULTS: Thienopyridine resistance rate was 28{\%}. Patients receiving clopidogrel had a significantly higher rate (32{\%}) of resistance, compared with those receiving ticlopidine (14{\%}) and thienopyridine resistance was significantly associated with platelet count (P = 0.006). The time taken to recover platelet function after thienopyridine discontinuation was variable between individuals; the only factor associated with a faster recovery time was the serum bilirubin value (P = 0.002). Platelet aggregation values high enough to avoid major bleeding were reached 3 days after discontinuation (95{\%} confidence interval: 2-4 days); however, a complete recovery of platelet function was reached only after 8 days (95{\%} confidence interval: 7-9 days). CONCLUSIONS: Patient-specific factors determine the effectiveness of thienopyridine treatment and platelet function recovery rate. Among these, platelet count (for thienopyridine resistance) and serum bilirubin values (for platelet function recovery rate) should be considered.",
keywords = "Bleeding, Coronary artery bypass surgery, Platelets",
author = "{Di Dedda}, Umberto and Marco Ranucci and Ekaterina Baryshnikova",
year = "2014",
month = "1",
doi = "10.1093/ejcts/ezt279",
language = "English",
volume = "45",
pages = "165--170",
journal = "European Journal of Cardio-thoracic Surgery",
issn = "1010-7940",
publisher = "European Association for Cardio-Thoracic Surgery",
number = "1",

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TY - JOUR

T1 - Thienopyridines resistance and recovery of platelet function after discontinuation of thienopyridines in cardiac surgery patients

AU - Di Dedda, Umberto

AU - Ranucci, Marco

AU - Baryshnikova, Ekaterina

PY - 2014/1

Y1 - 2014/1

N2 - OBJECTIVES: Patients who undergo cardiac operations under the effects of thienopyridines have a greater risk of major postoperative bleeding, transfusions and surgical revision due to bleeding. Discontinuation of thienopyridine is suggested but an adequate recovery period following discontinuation is still under debate, with opinions ranging from 3 to 7 days. The aim of this study was to assess the rate of recovery of thienopyridine-resistant patients and the time taken for resumption of platelet function after discontinuation of thienopyridine, in the setting of patients scheduled for cardiac operations. METHODS: This was a retrospective study, based on 344 patients screened for platelet aggregation before cardiac operations. All the patients received thienopyridines within 7 days prior to the test. Multiple electrode aggregometry 0adenosine diphosphate test was used to assess platelet aggregation before the operation. RESULTS: Thienopyridine resistance rate was 28%. Patients receiving clopidogrel had a significantly higher rate (32%) of resistance, compared with those receiving ticlopidine (14%) and thienopyridine resistance was significantly associated with platelet count (P = 0.006). The time taken to recover platelet function after thienopyridine discontinuation was variable between individuals; the only factor associated with a faster recovery time was the serum bilirubin value (P = 0.002). Platelet aggregation values high enough to avoid major bleeding were reached 3 days after discontinuation (95% confidence interval: 2-4 days); however, a complete recovery of platelet function was reached only after 8 days (95% confidence interval: 7-9 days). CONCLUSIONS: Patient-specific factors determine the effectiveness of thienopyridine treatment and platelet function recovery rate. Among these, platelet count (for thienopyridine resistance) and serum bilirubin values (for platelet function recovery rate) should be considered.

AB - OBJECTIVES: Patients who undergo cardiac operations under the effects of thienopyridines have a greater risk of major postoperative bleeding, transfusions and surgical revision due to bleeding. Discontinuation of thienopyridine is suggested but an adequate recovery period following discontinuation is still under debate, with opinions ranging from 3 to 7 days. The aim of this study was to assess the rate of recovery of thienopyridine-resistant patients and the time taken for resumption of platelet function after discontinuation of thienopyridine, in the setting of patients scheduled for cardiac operations. METHODS: This was a retrospective study, based on 344 patients screened for platelet aggregation before cardiac operations. All the patients received thienopyridines within 7 days prior to the test. Multiple electrode aggregometry 0adenosine diphosphate test was used to assess platelet aggregation before the operation. RESULTS: Thienopyridine resistance rate was 28%. Patients receiving clopidogrel had a significantly higher rate (32%) of resistance, compared with those receiving ticlopidine (14%) and thienopyridine resistance was significantly associated with platelet count (P = 0.006). The time taken to recover platelet function after thienopyridine discontinuation was variable between individuals; the only factor associated with a faster recovery time was the serum bilirubin value (P = 0.002). Platelet aggregation values high enough to avoid major bleeding were reached 3 days after discontinuation (95% confidence interval: 2-4 days); however, a complete recovery of platelet function was reached only after 8 days (95% confidence interval: 7-9 days). CONCLUSIONS: Patient-specific factors determine the effectiveness of thienopyridine treatment and platelet function recovery rate. Among these, platelet count (for thienopyridine resistance) and serum bilirubin values (for platelet function recovery rate) should be considered.

KW - Bleeding

KW - Coronary artery bypass surgery

KW - Platelets

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