Thromboelastogram Assessment of Dual Antiplatelet Effect in Cardiac Surgery

Abstract

The management of patients on dual antiplatelet therapy (DAPT) prior to cardiac surgery is challenging. At least 10% of patients presenting with acute coronary syndromes require coronary artery bypass grafting (CABG). The standard of care is that these patients have received DAPT at presentation. However, preoperative cessation and washout may increase ischaemic events and disrupt hospital bed flow. Further, various guidelines and societies advocate different durations of preoperative DAPT washout: European Society of Cardiology, 3 days, and American College of Cardiology/American Heart Association, 5 days. This study sought to assess whether there was a difference in bleeding outcomes for patients proceeding to CABG earlier than 5 days based on thromboelastogram (TEG) assessment of their response to DAPT.