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August 14, 2009

Test Before You Stop—Reply

Arch Surg. 2009;144(8):787. doi:10.1001/archsurg.2009.143

In reply

We thank Drs Kumar and Roberts for their comments and interest in our article. Bedside platelet function testing could potentially provide the surgeon with a useful adjunct in treating patients taking antiplatelet agents in the perioperative period owing to variability between patients with regard to antiplatelet inhibition. However, platelet activation and aggregation involve multiple agonists and pathways, and the currently available laboratory-based techniques and bedside tests (eg, VerifyNow) used to assess platelet aggregation examine only 1 agonist and 1 pathway at a time. The criterion standard for assessing platelet aggregation remains light transmission aggregometry,1 which is time-consuming, expensive, and does not take place at the bedside. Therefore, basing clinical judgments on the outcomes of a single platelet aggregation assay, in its current format, could potentially lead to inappropriate decision-making. In the future, we hope to have a much more physiologic method of rapidly assessing platelet aggregation responses at the bedside.

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