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SHR Neuro Krebs Kardio Lipid

Metzler, H; Prüller, F; Münch, A; Primus, G; Kainz, J; Hödl, R; Rehak, P.
Premature preoperative discontinuation of antiplatelet drug therapy in cardiovascular risk patients: a preliminary study on the role of P2Y12 receptor monitoring.
Eur J Anaesthesiol. 2010; 27(2): 138-145. [OPEN ACCESS]
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Autor/innen der Med Uni Graz:
Kainz Johann
Metzler Helfried
Münch Andreas
Prüller Florian
Rehak Peter
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Abstract:
Background and objective In high-bleeding risk procedures, discontinuation of antiplatelet drug therapy with clopidogrel may be requested by surgeons, usually 7-10 days before the surgical procedure. New platelet function tests, such as the vasodilator-stimulated phosphoprotein phosphorylation assay, may help to assess the perioperative status of the clopidogrel-specific P2Y12 receptor. Methods Using vasodilator-stimulated phosphoprotein phosphorylation assay, the platelet reactivity index (PRI) was measured in 80 individuals, including 20 healthy volunteers, 20 cardialogic patients under full antiplatelet drug therapy with clopidogrel and aspirin, 20 surgical patients without any antiplatelet drugs and 20 patients under clopidogrel, discontinued 7 days before the surgical procedure. Results The mean PRI (95% confidence interval) in healthy volunteers was 86 (82-89%) and that in the surgical control group was 77% (72-81%). In cardiologic patients under full antiplatelet therapy, mean PRI was 51% (42-60%). In the clopidogrel discontinuation group, PRI increased from 51% (40-62%) on day 0 to 65% (57-74%) on day 3 and to 76% (69-84%) on day 5. On the morning of surgery, mean PRI was 85% (80-91%). The PRI values on the 5th day were equivalent to those of the surgical control group (mean difference -0.4%, 95% confidence interval -8.6% to 7.8%, P = 0.9). Fifty-five percent of the patients in the discontinuation group had a PRI of more than 50% on day 0. Conclusion The study using vasodilator-stimulated phosphoprotein phosphorylation assay, one of the new platelet function assays for the assessment of inhibition of platelet P2Y12 receptor, demonstrates that the PRI on day 5 after discontinuation of clopidogrel is equivalent to a surgical control group and it questions the rigid practice of delaying surgery for 7-10 days, particularly in patients without a clopidogrel effect. Eur J Anaesthesiol 27:138-145 (c) 2010 European Society of Anaesthesiology.
Find related publications in this database (using NLM MeSH Indexing)
Adult -
Aged -
Aspirin - administration and dosage
Blood Loss, Surgical - prevention and control
Cardiovascular Diseases - complications
Case-Control Studies -
Cell Adhesion Molecules - metabolism
Female -
Humans -
Male -
Microfilament Proteins - metabolism
Middle Aged -
Phosphoproteins - metabolism
Phosphorylation -
Platelet Aggregation Inhibitors - administration and dosage
Platelet Function Tests - methods
Preoperative Care - methods
Prospective Studies -
Receptors, Purinergic P2 - metabolism
Receptors, Purinergic P2Y12 -
Ticlopidine - administration and dosage
Time Factors -

Find related publications in this database (Keywords)
antiplatelet drugs
clopidogrel
coronary stents
noncardiac surgery
platelet function
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