Development of a concept for a personalized approach in the perioperative antiplatelet therapy administration/discontinuation management based on multiple electrode aggregometry in XXXX undergoing coronary artery surgery.

@entity1 @entity548 @entity63 @entity117 @entity453 @entity715 @entity857
UNASSIGNED: In @entity1 undergoing coronary artery surgery, improvements in clinical outcomes currently rely on continued refinements of the surgical technique and modulation of adjuvant pharmacotherapy. Despite medical and technological advances, negligible rate of @entity548 and @entity63 events still persist necessitating further improvements in @entity1 management. Platelet function testing (PFT) might play an important role in meticulous balancing between the risk of @entity548 and @entity715 events. A suitable balance can be achieved by implementing a personalized, PFT based approach in antiplatelet therapy (APT) administration/discontinuation management. Despite emerging evidence on the widespread variability in platelet inhibitory response to APT, numerous PFT devices and heterogeneity in reporting study results hamper pooling of the evidence which in turn results with a lack of consensus in "on treatment" platelet reactivity associated with @entity63 and @entity548 events in perioperative phase. The literature on multiple electrode aggregometry (Multiplate(  ); Roche Diagnostics, Mannheim, Germany) in @entity453 @entity1 was reviewed systematically. Based on the evidence evaluating the relationship between "drug specific" PFT and @entity548 or adverse @entity63 events, we sought to define therapeutic window for the most commonly administered antiplatelet drugs such as @entity117 (ASPI test) and @entity857 receptor blockers ( @entity857 test). Preoperatively, APT administration was primarily focused to avoid @entity548 complications. ASPI test value of 20 AUC and @entity857 test value of <73 AUC were set as cut-off values that delineate @entity548 tendency. Postoperatively, "therapeutic window" was set to avoid both @entity548 and adverse @entity63 events. Therapeutic ranges were as follows: 20 AUC  <  ASPItest   <=  30 AUC and 19AUC  <  @entity857   <=  46AUC, respectively. This is the first attempt to define PFT based "therapeutic window" according to, perioperative APT administration/discontinuation management would be targeted. It seems that the "one-size-fits-all" concept of perioperative APT administration management is outdated and further development of PFT based, personalized APT administration/discontinuation management is desirable. This concept therefore presents a possible step forward in @entity1 care and provides a platform for further interventional trials whereby the impact of its application on clinical outcomes would be validated.
