Platelet Reactivity-based DAPT Strategy Noninferior to Standard Care

A platelet reactivity-based strategy of dual antiplatelet therapy  (DAPT) in patients with acute coronary syndromes who recently underwent coronary artery bypass graft (CABG) was not inferior to standard care, new study results indicate. “Dual antiplatelet therapy is recommended for patients with acute coronary syndromes,” the authors wrote in the abstract. “Approximately 10% to 15% of these patients will undergo CABG surgery for index events, and current guidelines recommend stopping clopidogrel at least 5 days before CABG. This waiting time has clinical and economic implications.” Researchers for the Evaluation of Platelet Aggregability in the Release of CABG in Patients With ACS With DAPT (PLAT-CABG) study included 190 patients with acute coronary syndromes and indications for CABG (and taking aspirin and P2Y12 receptor inhibitors) were assigned to either a control group, a group where P2Y12 receptor inhibitors were withdrawn five to seven days prior to CABG, or a platelet reactivity-based intervention group. The researchers reported that within the first 24 hours of CABG surgery, median chest tube drainage was 350 mL in both the intervention and control groups (P<0.001 for noninferiority). The median time between decision to undergo CABG and the procedure time was 112 hours in the intervention group and 136 hours in the control group (P<0.001). In the intention-to-treat analysis, there was a 6.4% decrease in median in-hospital costs in the intervention group (P=0.014), with a decrease of 11.2% in the per protocol analysis (P=0.003). “A strategy based on platelet reactivity-guided is noninferior to the standard of care in patients with acute coronary syndromes awaiting CABG regarding peri-operative bleeding, significantly shortens the waiting time to CABG, and decreases hospital expenses,” the authors wrote in the study. The paper was published in the Journal of the American College of Cardiology.