Platelet function testing to time surgery in patients on dual antiplatelet therapy?

Summary

In patients pretreated with P₂Y₁₂ receptor inhibitors who need to undergo non-emergent cardiac or major non-cardiac surgery, current guidelines of the European Society of Cardiology recommend postponing surgery for at least five days after last intake of clopidogrel or ticagrelor, and for seven days after last intake of prasugrel, unless there is high risk of ischemic events. However, a fixed five to seven days preoperative waiting period may be challenged, in the presence of inter-individual variability in on-treatment platelet reactivity. Therefore, Society of Thoracic Surgeons guidelines suggest to base decisions about a surgical delay on platelet function although both, the optimal platelet function assay and a bleeding cutoff have not yet been defined by large scale multicenter trials. This review aims to provide an overview on current knowledge of P₂Y₁₂ receptor induced platelet inhibition and surgery related bleeding and the potential role of platelet function analysis to time surgery.

Zusammenfassung

Um Blutungskomplikationen und Transfusionen zu minimieren, wird von europäischen Fachgesellschaften empfohlen, Clopidogrel und Ticagrelor fünf Tage und Prasugrel sieben Tage vor elektiven kardiochirurgischen und großen nichtkardiochirurgischen Operationen abzusetzen, sofern nicht ein hohes Ischämierisiko oder Zeichen einer hohen Plätt-chenreaktivität für einen früheren Operationszeitpunkt sprechen. Demgegenüber empfehlen Richtlinien US-amerikanischer Fachgesellschaften, die präoperative Wartezeit an der gemessenen Thrombozytenfunktionshemmung zu orientieren, obwohl bisher weder ein “ideales” Testsystem noch ein “Blutungs-Cutoff” basierend auf großen multi-zentrischen Studien definiert wurden.

Diese Übersichtsarbeit soll den gegenwärtigen Kenntnisstand hinsichtlich Zusammenhang zwischen P₂Y₁₂-Rezeptorblocker-induzierter Plättchenhemmung und chirurgischer Blutung sowie den möglichen Stellenwert der Thrombozytenfunktionsanalyse bei chirurgischen Patienten darlegen.

Keywords

P₂Y₁₂ receptor inhibitors - surgery - preoperative - platelet function testing

Schlüsselwörter

P₂Y₁₂-Rezeptorblocker - Operation - präoperativ - Thrombozytenfunktionsanalyse

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