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British Journal of Anaesthesia 2009 102(4):492-498; doi:10.1093/bja/aep039
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© The Author [2009]. Published by Oxford University Press on behalf of The Board of Directors of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Assessment of platelet inhibition secondary to clopidogrel and aspirin therapy in preoperative acute surgical patients measured by Thrombelastography® Platelet MappingTM

T. C. Collyer1,*, D. J. Gray2, R. Sandhu2, J. Berridge3 and G. Lyons2

1 Academic Unit of Anaesthesia, Royal Perth Hospital, Perth, Australia
2 Department of Anaesthesia, St James's University Hospital, Leeds, UK
3 Department of Anaesthesia, Leeds General Infirmary, Leeds, UK

* Corresponding author. E-mail: tomcollyer{at}doctors.org.uk

Background: Increasing numbers of patients prescribed clopidogrel and aspirin are presenting for non-elective surgery. No consensus on the timing of surgery exists after withdrawal of antiplatelet and tests of platelet function are not routinely available. The Thrombelastography® Platelet MappingTM (TEG-PM) assay is designed to assess platelet inhibition secondary to antiplatelet therapy. We assessed its ability to detect platelet inhibition in preoperative acute surgical patients.

Methods: We conducted a prospective observational study in three groups of preoperative patients: those taking clopidogrel or aspirin up to admission, and a control group. TEG-PM was performed on the day of admission and alternate days until surgery.

Results: Mean (SD) platelet thromboxane A2 receptor inhibition in the control group was 17.5% (23.8) (n=20), 52.6% (32.3) (n=18) in the aspirin group, and 31.9% (27.6) (n=21) in the clopidogrel group (P<0.01). Mean (SD) platelet adenosine diphosphate (ADP) receptor inhibition in the control group was 47.8% (18.9) (n=20), 52.6% (19.7) (n=18) in the aspirin group, and 71.5% (18.4) (n=21) in the clopidogrel group (P<0.01). Among the clopidogrel group awaiting surgery, mean platelet ADP channel inhibition decreased on day 3 to 67.1% (24.7) (n=11), 48.8% (24.4) (n=4) on day 5, and 36.1% (15.9) (n=2) on day 7 (P=0.57).

Conclusions: TEG-PM can identify statistically significant platelet inhibition after antiplatelet therapy; however, the overlap in platelet receptor inhibition between the three groups is likely to limit the clinical usefulness of this test.

Keywords: blood, anticoagulation, aspirin; blood, coagulation; blood, platelets; measurement techniques, ThrombelastographTM


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This article has been cited by other articles:


Home page
 Br J AnaesthHome page
J. Kaur, N. Jones, S. Mallett, T. C. Collyer, and D. J. Gray
Thrombelastography(R) Platelet MappingTM is a useful preoperative tool in surgical patients taking antiplatelet medication
Br. J. Anaesth., August 1, 2009; 103(2): 304 - 305.
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Thrombelastography® Platelet MappingTM is a useful preoperative tool in surgical patients taking antiplatelet medication
Jasmeet Kaur, et al.
British Journal of Anaesthesia, 19 May 2009 [Full text]
Re: Thrombelastography® Platelet MappingTM is a useful preoperative tool in surgical patients taking antiplatelet medication
Thomas C Collyer, et al.
British Journal of Anaesthesia, 26 May 2009 [Full text]
Thrombelastograph Platelet Mapping, Platelet Inhibition and Perioperative Safety Implications.
Davide Cattano, et al.
British Journal of Anaesthesia, 4 Dec 2009 [Full text]

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