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Perioperative assessment of platelet function by Thromboelastograph® Platelet Mapping™ in cardiovascular patients undergoing non-cardiac surgery

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Abstract

Five percent of patients on dual antiplatelet therapy after coronary artery stent implantation will need non-cardiac surgery within the first year of therapy, and many more will need surgery later on. A function assay that evaluates platelet reactivity and inhibition by drug therapy is beneficial for such patients. Platelet Mapping assay (PM™) using the TEG® analyzer was tested in surgical patients. After IRB approval, 60 patients on combined aspirin and clopidogrel therapy were consented and enrolled. The TEG® maximal amplitude (MA) and the percentage (%) platelet inhibition were recorded and analyzed. Fifty-seven patients (mean age 65.7 ± 10.9 years) had preoperative data only. Distribution of preoperative ADP (43.6 ± 24.4 %) and AA inhibition (52.8 ± 30.2 %) was determined, as well as for the preoperative MA ADP (43.1 ± 15.9 mm) and MA AA (37.2 ± 19.6 mm), showing an offset of the effect of both medications starting from day 3. Patients with complete pre- and postoperative data were stratified depending on duration off antiplatelet therapy (≤3 days, 3–7 days and >7 days): n = 27, ADP % preop inhibition (43.2 ± 21.6 %), ADP % postop inhibition (32.3 ± 18.3 %), p = 0.048. Distribution of immediate pre- and post- ADP and AA % inhibitions, showing a possible reduction in Δ of inhibition for clopidogrel at 3 days, were also assessed. Conclusion: According to the findings, the TEG® PM™ assay might be a feasible approach to objectively evaluate the effects of aspirin and clopidogrel during the perioperative period and potentially guide drug management.

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Acknowledgments

We thank Ms. Anne Starr for her assistance in preparing and organizing the manuscript, Phil Millman, PharmD and Westy McClelland, DC, for support on data interpretation from the TEG® analyzer. This work was supported by financial support provided by the Department of Anesthesiology, The University of Texas Medical School at Houston, Houston, Texas. Haemonetics Corp., Braintree, MA, USA, supplied TEG® PM™ assay kits free of charge for the study.

Conflict of interest

Davide Cattano, M.D., Ph.D., is on the speaker bureau for Cadence, received research funding from Covidien, and Karl Storz Endoscopy, Germany. Carin A. Hagberg, M.D., has disclosed that she is a member of the speakers’ bureaus for Ambu A/S, Cook Medical, Covidien, and LMA North America; and has received equipment support from Aircraft Medical, Ambu A/S, Cook Medical, Karl Storz Endoscopy, King Systems, LMA North America, Mercury Medical, and Verathon Medical.

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Authors and Affiliations

  1. Department of Anesthesiology, University of Texas Medical School at Houston, 6431 Fannin Street, MSB 5.020, Houston, USA

    Davide Cattano, Alfonso V. Altamirano, Carmen Seitan, Carin A. Hagberg & Evan G. Pivalizza

  2. Department of Cardiology, University of Texas Medical School at Houston, Houston, USA

    Husnu E. Kaynak

  3. Biostatistics Epidemiology Research Design Core, Center for Clinical and Translational Sciences, Houston, USA

    Zhongxue Chen & Hanwen Huang

  4. Department of Medical and Surgical Critical Care, The University of Florence, Florence, Italy

    Rita Paniccia & Domenico Prisco

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  1. Davide Cattano
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  2. Alfonso V. Altamirano
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  3. Husnu E. Kaynak
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  4. Carmen Seitan
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  5. Rita Paniccia
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  6. Zhongxue Chen
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  7. Hanwen Huang
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  8. Domenico Prisco
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  9. Carin A. Hagberg
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  10. Evan G. Pivalizza
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Correspondence to Davide Cattano.

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Cattano, D., Altamirano, A.V., Kaynak, H.E. et al. Perioperative assessment of platelet function by Thromboelastograph® Platelet Mapping™ in cardiovascular patients undergoing non-cardiac surgery. J Thromb Thrombolysis 35, 23–30 (2013). https://doi.org/10.1007/s11239-012-0788-5

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  • DOI: https://doi.org/10.1007/s11239-012-0788-5

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