Platelet inhibition and bleeding complications in cardiac surgery: A review

Abstract

Dual antiplatelet therapy (DAPT) with acetylsalicylic acid and a P2Y12 inhibitor (clopidogrel, ticagrelor, or prasugrel) reduces thrombotic events in patients with acute coronary syndrome (ACS), but it is also associated with an increased risk of bleeding complications. Excessive bleeding in cardiac surgery patients is associated with increased morbidity and mortality and high costs. In this review, different aspects of platelet inhibition in cardiac surgery patients will be discussed, including direct effects on bleeding and transfusion requirements, discontinuation and reinstitution of antiplatelet drugs before and after surgery, and the use of perioperative platelet function testing.

Keywords:

• Platelets
• platelet inhibition
• bleeding
• cardiac surgery

Disclosure statement

E. C. H. has received speaker’s honoraria from AstraZeneca. A. J. has received speaker’s honoraria from AstraZeneca and Roche Diagnostics, honorarium for advisory boards from Roche Diagnostics, The Medicines Company and AstraZeneca, and support from AstraZeneca for investigator-initiated studies.