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J U N E 2 0 1 4 | O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E
SAFETY
antiplatelet therapy, including point-of-care platelet function testing and
the development of new drugs that work for patients who do not respond
to clopidogrel. One new antiplatelet drug, ticagrelor (Brilinta), has proven
to be pharmocodynamically effective in patients resistant to clopidogrel
and offers the added benefit of a faster offset. Typically, it takes a full
week for the effects of other antiplatelet agents to wear off, clearing the
way for surgery. The offset of ticagrelor, a re-versible inhibitor, takes just
5 days or less.
Platelet function testing critical
Just as personalizing antiplatelet therapy may
yield better patient outcomes, a personalized
approach to balancing bleeding and thrombo-
sis risks in outpatient surgery should also be
considered.
Close consultation and communication with
the patient's cardiologist is a key piece of this
approach. Surgical guidelines say platelet func-
tion testing should be considered. It's a class 2 recommendation, which
means the testing is suggested, but not mandated. The guidelines don't
stipulate which method to use.
At Sinai Hospital of Baltimore, many surgeons request pre-surgical
platelet function testing in patients on clopidogrel, which we are fortu-
nate to have access to on site. Blood is obtained via veni-puncture and
tested with thromboelastography, which employs analytical software to
provide quantitative and qualitative measurements of a clot's physical
properties. It's not a very labor intensive process, but it has to be done
by technicians skilled in the practice. Results are obtained within an
hour. An even easier test, Verify Now (
tinyurl.com/q9gewwy
), provides
results in about 10 minutes, although it hasn't yet been studied prospec-
Timing surgery
based on the
results of a platelet
function test can
reduce the need
for hospitalization
by 50%.
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