Is it possible? Predicting complications and morbidity in surgical patients on clopidogrel therapy with Thrombelastography Platelet Mapping.

摘要: Dear Editor, We read with great interest the article by Hossain et al., in April 2013 “Is discontinuation of clopidogrel necessary for intracapsular hip fracture surgery? Analysis 102 hemiarthroplasties”. An increasing number patients presenting anesthesia are taking and an even greater on combination antiplatelet therapies, potentially risk intraoperative perioperative bleeding. Hossain al. [1] found no increase complications or transfusions those without. Collyer [2], conducted a similar study 114 receiving regular therapy urgent surgery. While increased requiring blood transfusion during after surgery was noted off only 1 day, major were reported. It is our opinion that correlation between platelet function responsiveness to paramount importance. There significant individuality patient clopidogrel, suggesting individualized, evidence-based approach needed assess adverse outcomes therapy. We suggest use Thrombelastograph ® Platelet Mapping™ (TEG-PM) assay preoperative assessment ADP receptor inhibition. [2, 3], provided insight weak unpredictable responses acute coronary syndrome more than 4 days. This emphasizes importance measuring determine residual therapy. We assessed ability TEG-PM detect secondary and/or aspirin [4]. In expansion study, we 131 based days day Of 131, 16 followed continuously from time their clinic visit (Fig. 1; Table 1). Fig. 1 Whisker plot distribution comparing percent (%) inhibition clopidogrel. Anesthesia values presented red while green Table 1 Anesthesia (mean ± SD) separated into three groups ( 5 days) Two important findings were: (1) trend towards recovery 5 (2) 60 % population not effectively inhibited prospective observational 59 patients, [3] also observed decline % longer interruption as well inconsistent efficacy inhibit function. Our might be feasible objectively evaluate effects period, guide drug management avoid related hypercoagulability thrombosis bleeding risk. recommend larger correlating incidence older