Evidence map›Paper›PMID 42237384›Full record

ArticleThrombosis journal2026

Plasma PF4 is a reliable biomarker of platelet reactivity and predictive of bleeding risk in DAPT patients undergoing cardiac surgery.

Joseph Roux de Bezieux, Julien Amour, Aurélien Philippe, Jeanne Rancic, Nicolas Gendron, Sébastien Bertil, Marc Garnier, Pascale Gaussem, David M Smadja

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Article in Thrombosis journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

9 authors.

Joseph Roux de Bezieux *Paris Cardiovascular Research Center, Team Endotheliopathy and Hemostasis Disorders, Université Paris Cité, INSERM UMR-S 970, Paris, 75015, France.
Julien Amour *Institute of Perfusion, Critical Care Medicine and Anesthesiology in Cardiac Surgery (IPRA), Hôpital Privé Jacques Cartier, Massy, France.
Aurélien PhilippeParis Cardiovascular Research Center, Team Endotheliopathy and Hemostasis Disorders, Université Paris Cité, INSERM UMR-S 970, Paris, 75015, France.
Jeanne RancicParis Cardiovascular Research Center, Team Endotheliopathy and Hemostasis Disorders, Université Paris Cité, INSERM UMR-S 970, Paris, 75015, France.
Nicolas GendronParis Cardiovascular Research Center, Team Endotheliopathy and Hemostasis Disorders, Université Paris Cité, INSERM UMR-S 970, Paris, 75015, France.
Sébastien BertilHematology Department, AP-HP, European Georges Pompidou Hospital, Paris, 75015, France.
Marc GarnierDepartment of Anesthesiology and Critical Care, Assistance Publique-Hôpitaux de Paris (APHP), Université Pierre et Marie Curie, UMRS INSERM, CHU Pitié-Salpêtrière, Paris, 1166, France.
Pascale Gaussem *Paris Cardiovascular Research Center, Team Endotheliopathy and Hemostasis Disorders, Université Paris Cité, INSERM UMR-S 970, Paris, 75015, France.
David M Smadja *Paris Cardiovascular Research Center, Team Endotheliopathy and Hemostasis Disorders, Université Paris Cité, INSERM UMR-S 970, Paris, 75015, France. david.smadja@aphp.fr.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPlatelet activation is crucial for hemostasis and thrombosis, particularly in patients on antiplatelet therapy. Managing bleeding risk during cardiac surgery requires understanding platelet dynamics, especially when antiplatelet agents are maintained until the coronary artery bypass surgery (CABG).

aimsto explore the relevance of plasma levels of sCD40L, sP-Selectin, PF4, and NAP-2 in predicting bleeding events during CABG in patients under dual antiplatelet therapy (clopidogrel+aspirin, DAPT) or aspirin.

methodsPlatelet reactivity before CABG was assessed in 143 patients by plasma levels of sCD40L, sP-Selectin, PF4, and NAP-2 as well as platelet aggregation tests and platelet membrane expression of P-Selectin. Postoperative bleeding was monitored at 24 h with the chest tube blood output.

resultsPatients receiving DAPT demonstrated markedly reduced plasma levels of PF4 and NAP-2 compared to patients on aspirin alone (PF4: 676 vs. 992 ng/ml, p < 0.001; NAP-2: 167 vs. 281 ng/ml, p < 0.001). PF4 and NAP-2 levels correlated with 10 and 20 µM ADP-induced and collagen-induced platelet aggregation (p = 0.01) but not with arachidonic acid or PAR1ap as agonists. Platelet membrane P-Selectin expression before CABG was significantly correlated with PF4 and NAP-2 levels (r = 0.26, p < 0.001 for PF4, r = 0.23, p = 0.01 for NAP-2), confirming its role in reflecting basal platelet activation. sP-Selectin and sCD40L showed no significant correlation with any clinical outcomes, treatment group or platelet activation test whereas PF4 and NAP-2 were independently correlated with increased 24-hour bleeding volume (PF4: r =-0.19 p = 0.03; NAP-2: r=-0.17 p = 0.04).

conclusionPF4 is the most platelet-specific biomarker for predicting platelet reactivity and bleeding in patients receiving DAPT until the CABG. Plasma PF4 quantification could provide a simpler alternative to aggregation tests for predicting platelet reactivity, postoperative bleeding and could guide perioperative antiplatelet management.

Identifiers

PMID42237384
PMCPMC13235088

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.