INTRODUCTION
Preoperative administration of dual antiplatelet therapy (DAPT) in
patients undergoing urgent coronary artery bypass grafting (CABG)
surgery remains controversial. DAPT including aspirin and a
P2Y12-inhibitor is most administered before urgent CABG
in the setting of acute coronary syndrome (ACS) in accordance with the
current guidelines [1]. Although preoperative
P2Y12-inhibitor treatment is associated with reduced
occurrence of ischemic events, there is a clear evidence that it can
increase the risk of surgery-related bleeding, especially in the case of
the third-generation thienopyridines such as prasugrel [2]. Current
guidelines recommend a discontinuation of prasugrel a minimum of 7 days
before non-emergent cardiac surgery to allow the recovery of platelet
function and attenuate the risk of perioperative bleeding [1].
However, these recommendations do not account for highly variable
recovery of platelet reactivity following discontinuation of
P2Y12-inhibitor [3]. Prasugrel is an inactive
prodrug that is transformed into its active metabolite with a half-life
of 7 hours and results in a faster, more consistent platelet inhibition,
when compared to clopidogrel [1,2,4]. Preoperative point-of-care
(POC) platelet function testing (PFT) in patients receiving prasugrel
could be helpful to measure platelet reactivity and predict the risk of
perioperative bleeding and transfusion requirements [5-8]. We
presented a rare case of unexpected complete platelet function recovery
in a patient with ACS treated with prasugrel and revealed by
preoperative platelet function monitoring with thromboelastography (TEG)
platelet mapping before urgent surgical coronary revascularization.