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.