engleski

Management of antiplatelet therapy resistance in cardiac surgery

The role of coronary artery bypass grafting (CABG) in the management of complex coronary artery disease has been validated through an unparalleled level of scrutiny. Improvement in patient outcomes currently relies on continued refinements of the surgical technique and modulation of adjuvant pharmacotherapy. Postoperative antiplatelet therapy (APT) is paramount in maintaining the revascularization benefit. However, individual variability to APT results in unpredictable platelet inhibition. Currently available platelet function tests (PFTs) dichotomize patients into “responders” and “nonresponders” on the basis of arbitrarily defined cutoff points. It is not surprising that the incidence of APT resistance across the spectrum of PFTs is widely discrepant, underscoring the fact that single pathway descriptors of platelet aggregation fail to portray the complexity of the process. Thrombosis is the principal mode of failure of saphenous vein grafts (SVGs) in the early postoperative period.1 Reports on the increased incidence of SVG failure in patients experiencing antiplatelet agent resistance underscore the importance of recognizing this entity and intervening in a timely fashion. This review summarizes the various assay- dependent definitions of APT resistance, with their respective rates of occurrence. The clinical impact of on-therapy high residual platelet reactivity (hRPR) in the cardiac surgical arena is discussed. Finally, guidelines on individual tailoring of APT in patients found to retain high on-therapy platelet reactivity are suggested.

antiplatelet therapy ; coronary artery surgery ; drug resistance

nije evidentirano