Abstract Number: PB0876
Meeting: ISTH 2022 Congress
Background: The RAPID CABG (NCT02668562) randomized trial demonstrated early coronary artery bypass surgery (CABG), 2-3 days after ticagrelor cessation, was non-inferior in incurring perioperative bleeding compared to waiting 5-7 days. Platelet function testing has been proposed as a tool to guide timing to surgery. In this pre-specified platelet function sub-study, we evaluate perioperative platelet function as a determinant of bleeding.
Aims: To assess whether pharmacodyamic measurement of platelet function following ticagrelor cessation is a predictor of bleeding and ischemic outcomes.
Methods: Patients with acute coronary syndromes and requiring CABG were randomly assigned to early surgery, 2-3 days after ticagrelor cessation, vs standard delay of 5-7 days. Platelet function was measured using the VerifyNow P2Y12 assay before, immediately after and at 24, 48 and 72 hours post-CABG. The primary outcome was bleeding, defined as class 3 or 4 (severe and massive) universal definition of peri-operative bleeding (UDPB). Secondary outcomes included: other bleeding outcomes (BARC type 4, TIMI CABG-related bleeding, cardiac tamponade) and ischemic outcomes (CV death, stroke, myocardial infarction, refractory ischemia, urgent unplanned revascularization).
Results: In the per-protocol population, platelet function measures were available in 60/65 patients in the early group and 54/58 in the delayed group. At all perioperative time points, the delayed group had significantly higher platelet reactivity (Figure A). Proportion of patients with low platelet reactivity (LPR – defined by PRU < 85, a correlate to increased bleeding risk), was similar in the early (5%) vs. delayed (1.9%) groups (p=0.62). A higher proportion had high platelet reactivity (HPR, defined as PRU>208) in the delayed (89%) vs. the early (45%) group at time of surgery (p < 0.001). Preoperative platelet reactivity was not associated with blood loss (Figure B). Correlation to other bleeding and ischemic outcomes will be presented.
Conclusion(s): Platelet function recovery after ticagrelor cessation followed expected pharmacokinetics, but did not predict perioperative bleeding.
To cite this abstract in AMA style:Lordkipanidzé M, Wells G, Le May M, Rubens F, Chen L, Ruel M, Chong A, Welman M, Perrault L, Chan V, Tanguay J, So D. Platelet function testing and timing of bypass surgery – A platelet function sub-study from the RAPID CABG randomized trial [abstract]. https://abstracts.isth.org/abstract/platelet-function-testing-and-timing-of-bypass-surgery-a-platelet-function-sub-study-from-the-rapid-cabg-randomized-trial/. Accessed August 16, 2022.
« Back to ISTH 2022 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/platelet-function-testing-and-timing-of-bypass-surgery-a-platelet-function-sub-study-from-the-rapid-cabg-randomized-trial/