Reduction of Preoperative Waiting Time before Urgent Surgery for Patients on P2Y12 Inhibitors Using Multiple Electrode Aggregometry: A Retrospective Study

Michaël Hardy; Camie Dupuis; Anne-Sophie Dincq; Hugues Jacqmin; Thomas Lecompte; François Mullier; Sarah Lessire

doi:10.3390/jcm9020424

Reduction of Preoperative Waiting Time before Urgent Surgery for Patients on P2Y₁₂ Inhibitors Using Multiple Electrode Aggregometry: A Retrospective Study

J Clin Med. 2020 Feb 4;9(2):424. doi: 10.3390/jcm9020424.

Authors

Michaël Hardy^{1

2}, Camie Dupuis², Anne-Sophie Dincq², Hugues Jacqmin¹, Thomas Lecompte³, François Mullier¹, Sarah Lessire²

Affiliations

¹ 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.
² 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.
³ Departments of Medicine, University Hospitals of Geneva, and GpG-Faculty of Medicine Geneva University, 14 CH-1211 Geneva, Switzerland.

Abstract

P2Y₁₂ 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 P2Y₁₂ 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 P2Y₁₂ inhibitors.

Keywords: P2Y12 inhibitors; clopidogrel; multiplate; multiple electrode aggregometry; perioperative; prasugrel; preoperative; ticagrelor; urgent surgery.