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Platelet aggregability evaluation in patients with acute coronary syndromes scheduled for coronary artery bypass graft. The PLAT-CABG study

Session Poster Session 2

Speaker Talia Dalcoquio

Event : ESC Congress 2019

  • Topic : interventional cardiology and cardiovascular surgery
  • Sub-topic : Cardiovascular Surgery – Coronary Arteries
  • Session type : Poster Session

Authors : C A K Nakashima (Sao Paulo,BR), L A O Dallan (Sao Paulo,BR), L A F Lisboa (Sao Paulo,BR), L A Hajjar (Sao Paulo,BR), A M Soeiro (Sao Paulo,BR), B A Silva (Sao Paulo,BR), M S S Costa (Sao Paulo,BR), CJCB Dornas (Brasilia,BR), T F Dalcoquio (Sao Paulo,BR), R H M Furtado (Sao Paulo,BR), L M Baracioli (Sao Paulo,BR), J T Fukushima (Sao Paulo,BR), P A Gurbel (Durham,US), R P Giugliano (Boston,US), J C Nicolau (Sao Paulo,BR)

Authors:
C.A.K. Nakashima1 , L.A.O. Dallan1 , L.A.F. Lisboa1 , L.A. Hajjar1 , A.M. Soeiro1 , B.A. Silva1 , M.S.S. Costa1 , C.J.C.B. Dornas2 , T.F. Dalcoquio1 , R.H.M. Furtado1 , L.M. Baracioli1 , J.T. Fukushima1 , P.A. Gurbel3 , R.P. Giugliano4 , J.C. Nicolau1 , 1Heart Institute of the University of Sao Paulo (InCor) - Sao Paulo - Brazil , 2Hospital do Coracao do Brasil - Brasilia - Brazil , 3Duke University Medical Center - Durham - United States of America , 4Brigham and Womens Hospital - Boston - United States of America ,

On behalf: ANtiplatelet Therapy Study (ANTS) group

Citation:
European Heart Journal ( 2019 ) 40 ( Supplement ), 1134

Background: Dual antiplatelet therapy is recommended for patients (pts) with acute coronary syndromes (ACS). However, 10–15% of pts have indication of coronary artery bypass graft (CABG) for the index event and current guidelines recommend stopping clopidogrel at least 5 days prior to CABG. This waiting time could increase hospital length of stay, thus having negative impacts on costs and clinical complications.

Purpose: To evaluate if release to CABG based on platelet aggregability by Multiplate AnalyzerTM would be non-inferior in comparison with common practice (5 days) in terms of 24-hours post-CABG bleeding.

Methods: The PLAT-CABG (NCT 02516267) is a randomized, open label, non-inferiority trial (boundary 25%) testing a strategy of platelet aggregability-guided release to CABG versus standard-of-care on the primary endpoint of chest tube drainage in the first 24 hours post CABG. A total of 190 pts admitted with ACS, treated with aspirin + clopidogrel and with indication for CABG, were assigned to clopidogrel discontinued 5 days prior to CABG (control group) vs. daily measurements of platelet aggregability to ADP using Multiplate AnalyzerTM (intervention group) with CABG occurring after recovering from platelet inhibition (pre-defined as a threshold of 46 AU).

Results: The main results are depicted in the table

Conclusion: Platelet-aggregability guided release to CABG is non-inferior to standard of care in ACS patients awaiting CABG in terms of peri-operative bleeding and significantly shortens the time to CABG.

Main results of PLAT-CABG study
VariablesControl Group (n=95)Intervention Group (n=95)P-value for superiorityP-value for non-inferiority
Chest tube drainage (mL), Median (25th–75th)350 (250–500)350 (250–500)0.6800.001
Time symptom to CABG (hours), Median (25th–75th)191 (150–281)166 (119–225)<0.001NA
Time surgery indication to CABG (hours), Median (25th–75th)136 (112–161)112 (66–142)<0.001NA
CABG = coronary artery bypass graft.

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