In:
Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 4, No. suppl_1 ( 2011-11)
Abstract:
Background: Coronary artery bypass surgery (CABG) is typically delayed until 5 days after last clopidogrel dose, waiting for restoration of platelet reactivity units (PRU). We have investigated cost-effectiveness of CABG timing strategy involving daily platelet PRU testing and operating when platelet inhibition (PI) is less than 30%. Material and Methods: All consenting patients underwent daily PRU testing with point of care VerifyNow P2Y12 assay after receiving 600 mg of clopidogrel at the time of catheterization. Twenty-four hour interval was given between integrillin administration and testing. 29 patients (41% females, 34% with diabetes) comprised study cohort. Daily hospital cost for room and board was $3,770; cost of PRU testing was $49.The study was approved by the institutional IRB. Results: 83% of patients were operated on day 6 after the last clopidogrel dose; an additional 5 patients waited for more than 6 days. At least 75% of the tested patients demonstrated less than 30% PI, traditionally considered “safe” for a surgical intervention. There were no significant differences in RBC (p=0.949) or platelet (p=0.864) transfusion, fresh frozen plasma (p=0.295) or cryoprecipitate (p=0.654) administration in patients whose surgery was delayed for more than 6 days. Employing a strategy of operating on the day when PI is less than 30%, time to the surgery can be decreased from 5.3+/- 0.6 days to 2.8+/-1.5 days, Mann-Whitney p 〈 0.0001. Assuming no other expenses than cost of room and board in patients managed traditionally and added cost of daily PRU testing in platelet reactivity directed approach, average cost would decrease from $19,890+/-2,447 to $10,535+/-5,558 (Mann-Whitney p 〈 0.0001). Conclusions: Unless dictated by other clinical considerations, delaying CABG beyond 5 days after last clopidogrel dose is not justified. Five day waiting period is excessive with the majority of clopidogrel-treated patients achieving “safe” platelet responsiveness in less than 5 days. A strategy, involving daily platelet reactivity testing and performing CABG when PI is less than 30%, promises to bring significant cost-savings without compromising quality of delivered care.
Type of Medium:
Online Resource
ISSN:
1941-7713
,
1941-7705
DOI:
10.1161/circoutcomes.4.suppl_1.AP234
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2011
detail.hit.zdb_id:
2453882-6
