Assessment of platelet function in patients on antiplatelet therapy undergoing cardiac surgery: a review.

Increasing numbers of patients are undergoing cardiac surgery on dual antiplatelet therapy following previous percutaneous coronary intervention. The dilemma of stopping antiplatelet therapy prior to surgery with risk of stent thrombosis, versus continuation and risk of post-operative bleeding has received much debate. Currently, an accurate and standardised method of predicting antiplatelet drug efficacy has not yet been determined and significant inter-individual variance has been shown. This review focuses on the most widely used laboratory and point of care assays currently available to measure platelet function and recent published data evaluating these methods. Further studies may enable predictive values to be defined, to guide the practicing clinician in balancing the risk of thrombosis versus haemorrhage.

An audit of a steriod withdrawal regimen in cardiac transplantation patients.

BACKGROUND: Heart transplantation is optimal treatment for many patients with end-stage heart failure. Current data report 1-year graft survival rates of 85% after transplantation. The success of transplantation in large part is attributable to immunosuppression, including steroids, one of the mainstay agents. Despite its efficacy to treat acute graft rejection, steroids show numerous adverse effects. With newer immunosuppressive agents, steroid withdrawal is possible. MATERIAL AND METHODS: We compared cardiac transplant patients who died versus survived between 2001 and 2006. We obtained Personal, transplant, occurrence of and cause of death data as well as postoperative intervals. Steroid therapy details were gathered, particularly whether the patient had been weaned off these agents. We calculated steroid doses and steroid-free years, as well as the steroid therapy status of posttransplant patients who remained alive in 2006. RESULTS: Fifty cardiac transplant patients died between 2001 and 2006 excluding 6 who had graft failure and 2 who died of multiorgan failure before initial discharge. Of the 42 patient who died, 29 (69%) were on and 13 (31%) had been withdrawn from steroid therapy at time of death. There were 132 posttransplant patients currently alive in April 2006, including 43 (33%) on and 89 (67%) withdrawn from steroids. The percentages of patients who were on versus off steroids were compared for main causes of death. Thirty-eight percent of patients on steroids at the time of death died of graft vasculopathy compared with 46% of patients who had been weaned off steroids. Fifteen percent of deceased patients taking steroids at the time of death died of chronic rejection. DISCUSSION: The current literature focuses on early withdrawal or reduction of steroids or steroid avoidance after organ transplantation. Although steroid avoidance remains controversial, steroid withdrawal has been generally incorporated into immunosuppressive protocols. Early steroid withdrawal has a positive influence on the emergence of de novo osteoporosis and cataracts. The benefits of steroid avoidance versus withdrawal are controversial topics being currently debated.