Hardy Michaël, Dupuis Camie, Dincq Anne-Sophie, Jacqmin Hugues, Lecompte Thomas, Mullier François, Lessire Sarah
Haematology Laboratory, NAmur Research Institute for LIfe Sciences (NARILIS), Namur Thrombosis and Hemostasis Center (NTHC), Université catholique de Louvain, CHU UCL Namur, 5530 Yvoir, Belgium.
Department of Anesthesiology, Namur Research Institute for LIfe Sciences (NARILIS), Namur Thrombosis and Hemostasis Center (NTHC), Université catholique de Louvain, CHU UCL Namur, 5530 Yvoir, Belgium.
J Clin Med. 2020 Feb 4;9(2):424. doi: 10.3390/jcm9020424.
P2Y inhibitor discontinuation is essential before most surgical interventions to limit bleeding complications. Based on pharmacokinetic data, fixed discontinuation durations have been recommended. However, as platelet function recovery is highly variable among patients, a more individualized approach based on platelet function testing (PFT) has been proposed. The aim of this retrospective single-centre study was to determine whether PFT using whole blood adenosine diphosphate-multiple electrode aggregometry (ADP-MEA) was associated with a safe reduction of preoperative waiting time. Preoperative ADP-MEA was performed for 29 patients on P2Y inhibitors. Among those, 17 patients underwent a coronary artery bypass graft. Twenty one were operated with an ADP-MEA ≥ 19 U (quantification of the area under the aggregation curve), and the waiting time was shorter by 1.6 days (median 1.8 days, IQR 0.5-2.9), by comparison with the current recommendations (five days for clopidogrel and ticagrelor, seven days for prasugrel). Platelet function recovery was indeed highly variable among individuals. With the 19 U threshold, high residual platelet inhibition was associated with perioperative platelet transfusion. These results suggest that preoperative PFT with ADP-MEA could help reduce waiting time before urgent surgery for patients on P2Y inhibitors.
在大多数外科手术前停用P2Y抑制剂对于限制出血并发症至关重要。基于药代动力学数据，已推荐了固定的停药持续时间。然而，由于患者之间血小板功能恢复差异很大，因此有人提出了一种基于血小板功能检测（PFT）的更个体化方法。这项回顾性单中心研究的目的是确定使用全血二磷酸腺苷-多电极凝集法（ADP-MEA）进行的血小板功能检测是否与安全缩短术前等待时间相关。对29例服用P2Y抑制剂的患者进行了术前ADP-MEA检测。其中，17例患者接受了冠状动脉搭桥术。21例患者在ADP-MEA≥19 U（凝集曲线下面积的量化）时进行了手术，与当前建议（氯吡格雷和替格瑞洛为5天，普拉格雷为7天）相比，等待时间缩短了1.6天（中位数1.8天，四分位间距0.5-2.9天）。个体之间血小板功能恢复确实差异很大。以19 U为阈值，高残留血小板抑制与围手术期血小板输注相关。这些结果表明，对于服用P2Y抑制剂的患者，术前使用ADP-MEA进行血小板功能检测有助于缩短紧急手术前的等待时间。
