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tively.
Platelet testing may offer valuable insights into bleeding risks as
well as the risk of ischemic events. If platelet reactivity is low, we
tend to wait to do the surgery until the effects of antiplatelet meds
fully dissipate. If platelet reactivity is high, the blood is clotting well
and it's likely safe to proceed with the surgery from a bleeding per-
spective within 24 hours .
While point-of-care platelet function testing is being used more fre-
quently, it has yet to become standard of care. A study conducted by
my research team involving 200 patients showed that timing surgery
based on the thrombolastography results of a platelet function test
can reduce the surgical wait time and need for hospitalization by 50%
— an important consideration for outpatient surgery facilities. Large-
scale studies demonstrating that platelet function testing improves
patient outcomes would lead to a paradigm shift in pre-op assess-
ments and ultimately improve the overall quality of care for surgical
patients.
Reducing risks
Developing strategies to proactively avoid excessive bleeding and
thrombotic events during surgery is vitally important. Both conditions
increase morbidity and mortality, but may be reduced with thoughtful
planning and management, including platelet function test results and
the offset effects of the antiplatelet agents the patient is taking. OSM
Dr. Gurbel (
pg urb el@lifeb ridg ehealth.org
) is an interventional cardiologist
at Sinai Hospital of Baltimore and director of the Sinai Center for
Thrombosis Research in Baltimore, Md.
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