Platelet function measurement-based strategy to reduce bleeding and waiting time in clopidogrel-treated patients undergoing coronary artery bypass graft surgery: The timing based on platelet function strategy to reduce clopidogrel-associated bleeding related to CABG (TARGET-CABG) study

Elisabeth Mahla, Thomas A. Suarez, Kevin P. Bliden, Peter Rehak, Helfried Metzler, Alejandro J. Sequeira, Peter Cho, Jeffery Sell, John Fan, Mark J. Antonino, Udaya S. Tantry, Paul A. Gurbel

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)261-269
Number of pages9
JournalCirculation: Cardiovascular Interventions
Volume5
Issue number2
DOIs
StatePublished - Apr 1 2012

Keywords

  • Antiplatelet therapy
  • Bleeding
  • Cardiopulmonary bypass

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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