Development of a concept for a personalized approach in the perioperative antiplatelet therapy administration/discontinuation management based on multiple electrode aggregometry in patients undergoing coronary artery surgery

摘要: In patients undergoing coronary artery surgery, improvements in clinical outcomes currently rely on continued refinements of the surgical technique and modulation adjuvant pharmacotherapy. Despite medical technological advances, negligible rate bleeding ischemic events still persist necessitating further patient management. Platelet function testing (PFT) might play an important role meticulous balancing between risk thrombotic events. A suitable balance can be achieved by implementing a personalized, PFT based approach antiplatelet therapy (APT) administration/discontinuation emerging evidence widespread variability platelet inhibitory response to APT, numerous devices heterogeneity reporting study results hamper pooling which turn with lack consensus “on treatment” reactivity associated perioperative phase. The literature multiple electrode aggregometry (Multiplate®; Roche Diagnostics, Mannheim, Germany) disease was reviewed systematically. Based evaluating relationship “drug specific” or adverse events, we sought define therapeutic window for most commonly administered drugs such as aspirin (ASPI test) adenosine-diphosphate receptor blockers (ADP test). Preoperatively, APT administration primarily focused avoid complications. ASPI test value 20 AUC ADP <73 were set cut-off values that delineate tendency. Postoperatively, “therapeutic window” both Therapeutic ranges follows: AUC < ASPItest ≤ 30 19AUC < ADP ≤ 46AUC, respectively. This is first attempt according to, management would targeted. It seems “one-size-fits-all” concept outdated development based, personalized desirable. therefore presents possible step forward care provides platform interventional trials whereby impact its application validated.