Case reportPlatelet Mapping and Desmopressin Reversal of Platelet Inhibition During Emergency Carotid Endarterectomy
Section snippets
Case Report
A 57-year-old man was admitted with a diagnosis of acute myocardial infarction. Medical history included arterial hypertension and dyslipidemia under medical treatment, smoking, and chronic obstructive pulmonary disease. The patient was not taking chronic platelet inhibitor therapy. Myocardial enzymes (including troponin T) and the electrocardiogram confirmed the diagnosis of an acute posterolateral myocardial infarction. The patient underwent an angiographic examination that revealed complete
Discussion
Thienopyridine (clopidogrel and ticlopidine) antiplatelet therapy may induce different degrees of platelet dysfunction depending on the dosage and the individual susceptibility. A 300-mg loading dose of clopidogrel is generally able to induce a decrease in platelet aggregability to about 60% of normal after 4 hours.6 Standard coagulation tests are inadequate to assess the degree of this drug-induced platelet dysfunction.
PFA-100 is approved for testing the extent of aspirin-induced platelet
References (17)
- et al.
Timing of postcarotid complications: A guide to safe discharge planning
J Vasc Surg
(2001) - et al.
The platelet-inhibiting effect of a clopidogrel bolus dose in patients on long-term acetylsalicylic acid treatment
Thromb Res
(2007) - et al.
Controlled trial of desmopressin in liver cirrhosis and other conditions associated with a prolonged bleeding time
Blood
(1986) - et al.
Pharmacological strategies to decrease excessive blood loss in cardiac surgery: A meta-analysis of clinically relevant endpoints
Lancet
(1999) - et al.
Antiplatelet therapy for preventing stroke and other vascular events after carotid endarterectomy
Cochrane Database Syst Rev
(2003) - et al.
Beneficial effects of clopidogrel combined with aspirin in reducing cerebral emboli in patients undergoing carotid endarterectomy
Circulation
(2004) - et al.
The Clopidogrel and Aspirin for Reduction of Emboli in Symptomatic Carotid Stenosis (CARESS) Trial
Circulation
(2005) - et al.
Current practice in the use of antiplatelet agents in the perioperative period by UK vascular surgeons
Ann R Coll Surg Engl
(2003)
Cited by (35)
Emergent Reversal of Antithrombotics and Treatment of Life-Threatening Bleeding from Coagulopathies: A Clinical Review
2022, Journal of Emergency MedicineCitation Excerpt :Desmopressin works by increasing both von Willebrand factor and factor VIII. It also increases intracellular platelet concentrations, the formation of procoagulant platelets, and platelet adhesion to collagen (60–62). In the setting of ICH, platelets are generally only considered for surgical patients undergoing evacuation (3,63–67).
Management of antiplatelet therapy for non elective invasive procedures of bleeding complications: proposals from the French working group on perioperative haemostasis (GIHP), in collaboration with the French Society of Anaesthesia and Intensive Care Medicine (SFAR)
2019, Anaesthesia Critical Care and Pain MedicineManagement of antiplatelet therapy for non-elective invasive procedures or bleeding complications: Proposals from the French Working Group on Perioperative Haemostasis (GIHP) and the French Study Group on Thrombosis and Haemostasis (GFHT), in collaboration with the French Society for Anaesthesia and Intensive Care (SFAR)
2019, Archives of Cardiovascular DiseasesCitation Excerpt :Desmopressin is used for certain inherited [67] or acquired [68] platelet dysfunctions, but clinical demonstration of its efficacy has been inadequate. Studies with platelet function testing suggest a certain efficacy on the platelet dysfunctions induced by APAs [69–71]. In cardiac surgery, a meta-analysis of 10 randomized trials suggests that desmopressin can reduce red blood cell transfusion, blood loss and, more interestingly, reoperations resulting from bleeding [72].
Hemorrhagic Complications of External Ventriculostomy in the Aspirin and P2Y12 Response Assay Era
2019, World NeurosurgeryCitation Excerpt :Patients taking ASA and clopidogrel are at increased risk of periprocedural hemorrhage. Therefore, knowledge of platelet function status can aid in transfusing patients with platelets or administering desmopressin before medical procedures that may result in reduced adverse outcomes.21-23 The VerifyNow test also may be beneficial in neurosurgical procedures, as antiplatelet therapy in the greater than 75-year-old age group has been shown to correlate with threefold increase in mortality with traumatic intracerebral hemorrhage.24
Chronic Subdural Hematoma ICU Management
2017, Neurosurgery Clinics of North AmericaIntracerebral hemorrhage after pipeline embolization: Management of antiplatelet agents and the case for point-of-care testing - Case reports and review of literature
2014, Clinical Neurology and NeurosurgeryCitation Excerpt :Qureshi et al. [22] observed rapid reduction in the platelet inhibition following intravenous injection of methylprednisolone in a patient with ICH receiving clopidogrel and aspirin. Temporary improvement of platelet function has also been reported with thromboelastogram after desmopressin injection [23]. Flow diversion is now increasingly used for the treatment of cerebral aneurysms [5–7,14].