Utility of Pre-operative P2Y12 Levels for Perioperative Bleeding Risk in Isolated Coronary Artery Bypass Surgery

A retrospective review of patients at a single institution who underwent isolated coronary artery bypass (CABG) surgery between 2017 and 2023 was conducted to investigate the clinical utility of pre-operatively measuring platelet inhibition as a predictor of bleeding complications, especially in the context of bypass surgery. Patients who underwent CABG procedure and were on P2Y12 inhibitors such as clopidogrel or ticagrelor preoperatively and had preoperative P2Y12 platelet reactivity unit (PRU) level measured. Patients were stratified by a PRU <200 or ≥200. In both groups, patients were divided into patients who took clopidogrel and patients who took ticagrelor. There were 189 patients included in the study. Patients with a PRU ≥200 were of similar age and comorbidities to those with a PRU <200, however, more were female. Both groups had a similar mean duration of days since last P2Y12 inhibitor dose prior to surgery. There were greater intraoperative platelet transfusions in the PRU <200 group (mean 0.7 vs 0.3 units, P = 0.001). Intraoperative red blood cell and plasma transfusion and postoperative transfusions, 24-hour chest tube output, and re-exploration for bleeding were similar between the groups. There were no differences in bleeding complications between pharmacologic agent in either group. Our findings suggest that preoperative assessment of P2Y12 PRU may have limited clinical utility at a cutoff of 200 in predicting bleeding in patients undergoing CABG. Patients with PRU <200 received higher rates of platelet transfusion, without differences in other blood products.