Individualized Approach for Patients Undergoing Cardiac Surgery under Dual-Platelet Inhibition

Objective: Bleeding complications in patients undergoing cardiac surgery are expected more often with dual (DAPT) than with single (SAPT) antiplatelet therapy. We sought to determine the influence of different antiplatelet medications and discontinuation times before surgery on bleeding complications and DAPT responder status after surgery.

Methods: Thirty patients with SAPT (acetylsalicylic acid) and 26 patients with DAPT (acetylsalicylic acid plus clopidogrel, n = 14 or ticagrelor, n = 11) were observed prospectively before cardiac surgery. Patients with DAPT were daily screened for platelet function by aggregometry (Multiplate, Roche, Mannheim, Germany) and operated on only when ADP and ASPI values were below 53 and 73, respectively. 25 patients were not screened for platelet function because they had to undergo immediate surgery. The amounts of bleeding and of transfusions were observed, platelet function was measured before, during and after surgery.

Results: Only one rethoracotomy and two deaths (unscreened group) occurred in the whole patient population (n = 81). No adverse events occurred during the waiting time of DAPT patients. DAPT patients waiting for normalization of ADP and ASPI values had similar blood loss (900 ± 419 mL/24 hour) and transfusions rates (66%) as SAPT patients (Blood loss 750 ± 288 mL/24 hour, Transfusion 57%). In unscreened patients, blood loos (780 ± 870 mL/24 hour) was highest, but transfusion rate (64%) was similar. Mean blood loss in DAPT patients with clopidogrel (890 mL/24 hour) was similar to DAPT patients with ticagrelor (1020 mL/24 hour).

Conclusion: In stable DAPT patients admitted for cardiac surgery, screening platelet function before surgery to define the best time point for surgery is useful and safe. DAPT substances dońt differ regarding blood loss and transfusion rate after surgery.