TY - JOUR
T1 - Platelet function measurement-based strategy to reduce bleeding and waiting time in clopidogrel-treated patients undergoing coronary artery bypass graft surgery
T2 - The timing based on platelet function strategy to reduce clopidogrel-associated bleeding related to CABG (TARGET-CABG) study
AU - Mahla, Elisabeth
AU - Suarez, Thomas A.
AU - Bliden, Kevin P.
AU - Rehak, Peter
AU - Metzler, Helfried
AU - Sequeira, Alejandro J.
AU - Cho, Peter
AU - Sell, Jeffery
AU - Fan, John
AU - Antonino, Mark J.
AU - Tantry, Udaya S.
AU - Gurbel, Paul A.
N1 - Copyright:
Copyright 2012 Elsevier B.V., All rights reserved.
PY - 2012/4
Y1 - 2012/4
N2 - Background-Aspirin and clopidogrel therapy is associated with a variable bleeding risk in patients undergoing coronary artery bypass graft surgery (CABG). We evaluated the role of platelet function testing in clopidogrel-treated patients undergoing CABG. Methods and Results-One hundred eighty patients on background aspirin with/without clopidogrel therapy undergoing elective first time isolated on-pump CABG were enrolled in a prospective single-center, nonrandomized, unblinded investigation (Timing Based on Platelet Function Strategy to Reduce Clopidogrel-Associated Bleeding Related to CABG [TARGET-CABG] study) between September 2008 and January 2011. Clopidogrel responsiveness (ADPinduced platelet-fibrin clot strength [MA ADP]) was determined by thrombelastography; CABG was done within 1 day, 3-5 days, and >5 days in patients with an MA ADP >50 mm, 35-50 mm, and <35 mm, respectively. The primary end point was 24-hour chest tube drainage and key secondary end point was total number of transfused red blood cells. Equivalence was defined as ≤25% difference between groups. ANCOVA was used to adjust for confounders. Mean 24-hour chest tube drainage in clopidogrel-treated patients was 93% (95% confidence interval, 81-107%) of the amount observed in clopidogrel-naive patients, and the total amount of red blood cells transfused did not differ between groups (1.80 U versus 2.08 U, respectively, P=0.540). The total waiting period in clopidogrel-treated patients was 233 days (mean, 2.7 days per patient). Conclusions-A strategy based on preoperative platelet function testing to determine the timing of CABG in clopidogrel-treated patients was associated with the same amount of bleeding observed in clopidogrel-naive patients and ≈50% shorter waiting time than recommended in the current guidelines. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00857155.
AB - Background-Aspirin and clopidogrel therapy is associated with a variable bleeding risk in patients undergoing coronary artery bypass graft surgery (CABG). We evaluated the role of platelet function testing in clopidogrel-treated patients undergoing CABG. Methods and Results-One hundred eighty patients on background aspirin with/without clopidogrel therapy undergoing elective first time isolated on-pump CABG were enrolled in a prospective single-center, nonrandomized, unblinded investigation (Timing Based on Platelet Function Strategy to Reduce Clopidogrel-Associated Bleeding Related to CABG [TARGET-CABG] study) between September 2008 and January 2011. Clopidogrel responsiveness (ADPinduced platelet-fibrin clot strength [MA ADP]) was determined by thrombelastography; CABG was done within 1 day, 3-5 days, and >5 days in patients with an MA ADP >50 mm, 35-50 mm, and <35 mm, respectively. The primary end point was 24-hour chest tube drainage and key secondary end point was total number of transfused red blood cells. Equivalence was defined as ≤25% difference between groups. ANCOVA was used to adjust for confounders. Mean 24-hour chest tube drainage in clopidogrel-treated patients was 93% (95% confidence interval, 81-107%) of the amount observed in clopidogrel-naive patients, and the total amount of red blood cells transfused did not differ between groups (1.80 U versus 2.08 U, respectively, P=0.540). The total waiting period in clopidogrel-treated patients was 233 days (mean, 2.7 days per patient). Conclusions-A strategy based on preoperative platelet function testing to determine the timing of CABG in clopidogrel-treated patients was associated with the same amount of bleeding observed in clopidogrel-naive patients and ≈50% shorter waiting time than recommended in the current guidelines. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00857155.
KW - Antiplatelet therapy
KW - Bleeding
KW - Cardiopulmonary bypass
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U2 - 10.1161/CIRCINTERVENTIONS.111.967208
DO - 10.1161/CIRCINTERVENTIONS.111.967208
M3 - Article
C2 - 22396581
AN - SCOPUS:84860789698
SN - 1941-7640
VL - 5
SP - 261
EP - 269
JO - Circulation: Cardiovascular Interventions
JF - Circulation: Cardiovascular Interventions
IS - 2
ER -