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Thet MS, Khosravi A, Egbulonu S, Oo AY. Antiplatelet Resistance in Coronary Artery Bypass Grafting: A Systematic Review. Surg Res Pract 2024; 2024:1807241. [PMID: 38910604 PMCID: PMC11193597 DOI: 10.1155/2024/1807241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 05/26/2024] [Accepted: 06/08/2024] [Indexed: 06/25/2024] Open
Abstract
Background This systematic review examines the occurrence and implications of resistance to primary antiplatelet agents, aspirin and clopidogrel, often utilised in patients undergoing coronary artery bypass grafting (CABG), alongside the methodologies for assessment of such resistance. Methods An extensive literature search across various databases such as PubMed, MEDLINE via Ovid, Embase, and Cochrane CENTRAL until May 2024 was conducted to identify studies evaluating antiplatelet resistance in on-pump and off-pump CABG patients. Following quality assessment, only high-quality studies were incorporated into this review. Results This review included 19 studies with 3,915 patients, four of which were randomised controlled trials and 15 were observational studies. Aspirin resistance incidence ranged from 11.0% to 51.5%, while clopidogrel resistance was 22%. Antiplatelet resistance, assessed through a wide variety of methods, was associated with a 13 times increase in the risk of vein graft occlusion and increased rates of mortality, myocardial infarction, and target vessel revascularisation in the case of clopidogrel resistance. The effect of cardiopulmonary bypass on antiplatelet resistance remains ambiguous. Conclusion The academic literature lacks a standardised definition for antiplatelet resistance. Assessment methodologies greatly vary, leading to noninterchangeable outcomes. While aspirin resistance has a conflicting overall significant impact on adverse outcomes, clopidogrel resistance correlates with poorer clinical outcomes.
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Affiliation(s)
- Myat Soe Thet
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Amir Khosravi
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Samson Egbulonu
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, UK
| | - Aung Ye Oo
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, UK
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Turnbull RE, Hafeez A, Sander KN, Barrett DA, Murphy GJ, Goodall AH. Unfractionated heparin reverses aspirin inhibition of platelets during coronary artery bypass graft surgery. Sci Rep 2024; 14:8572. [PMID: 38609431 PMCID: PMC11015001 DOI: 10.1038/s41598-024-58005-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Unfractionated heparin (UFH) is an effective antithrombotic during surgery but has known adverse effects, in particular on platelets. A marked increase in platelet responsiveness has previously been observed in patients within minutes of receiving UFH, despite adequate inhibition by aspirin prior to heparin. We studied this phenomenon in patients undergoing cardiac artery bypass grafting (n = 17) to determine whether the effects of heparin were systemic or platelet-specific. All patients' platelets were fully inhibited by aspirin prior to surgery, but within 3 min of receiving heparin spontaneous aggregation and responses to arachidonic acid (AA) and ADP increased significantly (p ≥ 0.0002), and activated platelets were found in the circulation. While there was no rise in thromboxane in the plasma following heparin, levels of the major platelet 12-lipoxygenase product, 12-HETE, rose significantly. Mixing experiments demonstrated that the changes caused by heparin resided primarily in the platelets, while addition of AA pathway inhibitors, and analysis of oxylipins provided evidence that, following heparin, aggregating platelets regained their ability to synthesise thromboxane. These findings highlight potentially unrecognised pro-thrombotic and pro-inflammatory changes during CABG surgery, and provide further evidence of adverse effects associated with UFH.
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Affiliation(s)
- Robert E Turnbull
- Department of Cardiovascular Sciences, University of Leicester and NIHR Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, UK.
- The Leicester Institute of Structural and Chemical Biology and Department of Molecular and Cell Biology, University of Leicester, Lancaster Road, Leicester, LE1 7HB, UK.
| | - Azhar Hafeez
- Department of Cardiovascular Sciences, University of Leicester and NIHR Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, UK
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, S10 2HQ, UK
| | - Katrin N Sander
- Centre for Analytical Bioscience, Advanced Materials and Healthcare Division, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - David A Barrett
- Centre for Analytical Bioscience, Advanced Materials and Healthcare Division, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Gavin J Murphy
- Department of Cardiovascular Sciences, University of Leicester and NIHR Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Alison H Goodall
- Department of Cardiovascular Sciences, University of Leicester and NIHR Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, UK
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3
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Once- versus Twice-Daily Aspirin in Patients at High Risk of Thrombotic Events: Systematic Review and Meta-Analysis. Am J Cardiovasc Drugs 2021; 21:63-71. [PMID: 32394295 DOI: 10.1007/s40256-020-00409-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Acetylsalicylic acid (ASA) is a frequently used antiplatelet agent, although some individuals have reduced antiplatelet responses on ASA, with recurrent ischemic events. It has been proposed that shortening the ASA dosing interval may overcome the time-dependent renewal of the drug target, leading to a greater antiplatelet effect. We conducted a systematic review of randomized controlled trials (RCTs) to determine the efficacy of once- versus twice-daily ASA in conditions with increased platelet turnover. METHODS We conducted a systematic review and meta-analysis by searching the CENTRAL, MEDLINE, and Embase databases for RCTs assessing once- versus twice-daily ASA. Data were screened, extracted, and appraised by two independent reviewers, and were pooled using a random-effects model. The primary outcomes were major adverse cardiovascular events (MACEs) and serum thromboxane B2 (TxB2). Other pharmacodynamic measures were retrieved as secondary outcomes. Results were reported as mean differences with corresponding 95% confidence intervals (CIs). We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Seven RCTs were included, enrolling 379 participants overall. None of the studies reported clinical outcomes. Pooled results showed that compared with once-daily ASA, twice-daily ASA was associated with a decrease in mean TxB2 of 1.42 ng/mL (95% CI - 2.71 to - 0.13; I2 = 66%). We found no differences in subgroup analyses based on disease subtype, trial blinding, or trial design. A greater antiplatelet activity of the twice-daily regimen was also found when using PFA-100-ADP methods, although not when using the VerifyNow, LTA-AA, and multiplate methods. CONCLUSIONS Twice-daily ASA was associated with a greater antiplatelet effect compared with standard once-daily ASA.
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4
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Simeone P, Boccatonda A, Liani R, Santilli F. Significance of urinary 11-dehydro-thromboxane B 2 in age-related diseases: Focus on atherothrombosis. Ageing Res Rev 2018; 48:51-78. [PMID: 30273676 DOI: 10.1016/j.arr.2018.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/13/2018] [Accepted: 09/23/2018] [Indexed: 12/13/2022]
Abstract
Platelet activation plays a key role in atherogenesis and atherothrombosis. Biochemical evidence of increased platelet activation in vivo can be reliably obtained through non-invasive measurement of thromboxane metabolite (TXM) excretion. Persistent biosynthesis of TXA2 has been associated with several ageing-related diseases, including acute and chronic cardio-cerebrovascular diseases and cardiovascular risk factors, such as cigarette smoking, type 1 and type 2 diabetes mellitus, obesity, hypercholesterolemia, hyperhomocysteinemia, hypertension, chronic kidney disease, chronic inflammatory diseases. Given the systemic nature of TX excretion, involving predominantly platelet but also extraplatelet sources, urinary TXM may reflect either platelet cyclooxygenase-1 (COX-1)-dependent TX generation or COX-2-dependent biosynthesis by inflammatory cells and/or platelets, or a combination of the two, especially in clinical settings characterized by low-grade inflammation or enhanced platelet turnover. Although urinary 11-dehydro-TXB2 levels are largely suppressed with low-dose aspirin, incomplete TXM suppression by aspirin predicts the future risk of vascular events and death in high-risk patients and may identify individuals who might benefit from treatments that more effectively block in vivo TX production or activity. Several disease-modifying agents, including lifestyle intervention, antidiabetic drugs and antiplatelet agents besides aspirin have been shown to reduce TX biosynthesis. Taken together, these aspects may contribute to the development of promising mechanism-based therapeutic strategies to reduce the progression of atherothrombosis. We intended to critically review current knowledge on both the pathophysiological significance of urinary TXM excretion in clinical settings related to ageing and atherothrombosis, as well as its prognostic value as a biomarker of vascular events.
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Affiliation(s)
- Paola Simeone
- Department of Medicine and Aging, and Center of Aging Science and Translational Medicine (CESI-Met), Via Luigi Polacchi, Chieti, Italy
| | - Andrea Boccatonda
- Department of Medicine and Aging, and Center of Aging Science and Translational Medicine (CESI-Met), Via Luigi Polacchi, Chieti, Italy
| | - Rossella Liani
- Department of Medicine and Aging, and Center of Aging Science and Translational Medicine (CESI-Met), Via Luigi Polacchi, Chieti, Italy
| | - Francesca Santilli
- Department of Medicine and Aging, and Center of Aging Science and Translational Medicine (CESI-Met), Via Luigi Polacchi, Chieti, Italy.
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5
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Low-Dose Aspirin Is Safe and Effective for Venous Thromboembolism Prophylaxis Following Total Knee Arthroplasty. J Arthroplasty 2018; 33:S131-S135. [PMID: 29656974 DOI: 10.1016/j.arth.2018.03.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/02/2018] [Accepted: 03/03/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Aspirin is an effective prophylaxis for venous thromboembolism (VTE) after total knee arthroplasty (TKA). The optimal prophylactic aspirin dose has not been established. The study aims to compare 2 aspirin regimens with regard to the incidence of (1) symptomatic deep venous thrombosis (DVT), (2) pulmonary embolism (PE), (3) bleeding, and (4) mortality within 90 days after TKA. METHODS We retrospectively identified 5666 patients who received aspirin twice daily for 4 to 6 weeks after TKA. A total of 1327 patients received 81-mg BID and 4339 patients received 325-mg BID aspirin. Postoperative complications collected were VTEs (DVT and PE), bleeding (gastrointestinal or wound bleeding), and mortality. RESULTS The incidence of VTE was 1.5% in the 325-mg group and 0.7% in the 81-mg group (P = .02). Symptomatic DVT was 1.4% in the 325-mg aspirin compared with 0.3% for the 81-mg aspirin (P = .0009). Regression model showed no correlation between aspirin dose and VTE incidence (odds ratio [OR] = 1.03; 95% confidence interval [95% CI], 0.45-2.36; P = .94) or DVT (OR = 0.50; 95% CI, 0.16-1.55; P = .20). The incidence of PE was 0.2% in the high-aspirin group compared with 0.4% in the low-aspirin group (P = .13). Bleeding was 0.2% in the 325-mg aspirin group and 0.2% in the 81-mg aspirin group (P = .62), and 90-day mortality was similar (0.1%) between the groups (P = .56). CONCLUSION Low-dose aspirin was not inferior to high-dose aspirin for the prevention of VTE after TKA. Low-dose aspirin can be considered a safe and effective agent in the prevention of VTE after TKA.
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Olechowski B, Khanna V, Mariathas M, Ashby A, Dalton RT, Nordon I, Englyst N, Harris S, Nicholas Z, Thayalasamy K, Mahmoudi M, Curzen N. Changes in platelet function with inflammation in patients undergoing vascular surgery. Platelets 2017; 30:190-198. [DOI: 10.1080/09537104.2017.1392498] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Bartosz Olechowski
- Wessex Cardiothoracic Centre University, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Vikram Khanna
- Wessex Cardiothoracic Centre University, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mark Mariathas
- Wessex Cardiothoracic Centre University, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Alexander Ashby
- Wessex Cardiothoracic Centre University, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Richard T Dalton
- Wessex Cardiothoracic Centre University, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ian Nordon
- Wessex Cardiothoracic Centre University, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nicola Englyst
- Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Scott Harris
- Wessex Cardiothoracic Centre University, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Zoe Nicholas
- Wessex Cardiothoracic Centre University, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kala Thayalasamy
- Wessex Cardiothoracic Centre University, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Michael Mahmoudi
- Wessex Cardiothoracic Centre University, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nick Curzen
- Wessex Cardiothoracic Centre University, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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7
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Cavalca V, Rocca B, Veglia F, Petrucci G, Porro B, Myasoedova V, De Cristofaro R, Turnu L, Bonomi A, Songia P, Cavallotti L, Zanobini M, Camera M, Alamanni F, Parolari A, Patrono C, Tremoli E. On-pump Cardiac Surgery Enhances Platelet Renewal and Impairs Aspirin Pharmacodynamics: Effects of Improved Dosing Regimens. Clin Pharmacol Ther 2017; 102:849-858. [DOI: 10.1002/cpt.702] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 03/27/2017] [Accepted: 03/29/2017] [Indexed: 12/11/2022]
Affiliation(s)
- V Cavalca
- Monzino Cardiology Center, IRCCS; Milan Italy
- University of Milan; Milan Italy
| | - B Rocca
- Department of Pharmacology; Catholic University; Rome Italy
| | - F Veglia
- Monzino Cardiology Center, IRCCS; Milan Italy
| | - G Petrucci
- Department of Pharmacology; Catholic University; Rome Italy
| | - B Porro
- Monzino Cardiology Center, IRCCS; Milan Italy
| | | | | | - L Turnu
- Monzino Cardiology Center, IRCCS; Milan Italy
- University of Milan; Milan Italy
| | - A Bonomi
- Monzino Cardiology Center, IRCCS; Milan Italy
| | - P Songia
- Monzino Cardiology Center, IRCCS; Milan Italy
- University of Milan; Milan Italy
| | | | - M Zanobini
- Monzino Cardiology Center, IRCCS; Milan Italy
| | - M Camera
- Monzino Cardiology Center, IRCCS; Milan Italy
- University of Milan; Milan Italy
| | - F Alamanni
- Monzino Cardiology Center, IRCCS; Milan Italy
- University of Milan; Milan Italy
| | - A Parolari
- Policlinico San Donato Hospital, IRCCS; San Donato Milanese Italy
| | - C Patrono
- Department of Pharmacology; Catholic University; Rome Italy
| | - E Tremoli
- Monzino Cardiology Center, IRCCS; Milan Italy
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8
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Bliden KP, Patrick J, Pennell AT, Tantry US, Gurbel PA. Drug delivery and therapeutic impact of extended-release acetylsalicylic acid. Future Cardiol 2015; 12:45-58. [PMID: 26356085 DOI: 10.2217/fca.15.60] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Current treatment guidelines recommend once-daily, low-dose acetylsalicylic acid (ASA; aspirin) for secondary prevention of cardiovascular events. However, the anti-thrombotic benefits of traditional ASA formulations may not extend over a 24-h period, especially in patients at high risk for a recurrent cardiovascular event. A next-generation, extended-release ASA formulation (ER-ASA) has been developed to provide 24-h anti-thrombotic coverage with once-daily dosing. The pharmacokinetics of ER-ASA indicates slower absorption and prolonged ASA release versus immediate-release ASA, with a favorable safety profile. ER-ASA minimizes systemic ASA absorption and provides sustained antiplatelet effects over a 24-h period.
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Affiliation(s)
- Kevin P Bliden
- Sinai Center for Thrombosis Research, Baltimore, MD, USA
| | - Jeff Patrick
- New Haven Pharmaceuticals, Inc., North Haven, CT, USA
| | | | - Udaya S Tantry
- Sinai Center for Thrombosis Research, Baltimore, MD, USA
| | - Paul A Gurbel
- Sinai Center for Thrombosis Research, Baltimore, MD, USA
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9
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Mir A, Frank S, Journeycake J, Wolovits J, Guleserian K, Heistein L, Lemler M. Aspirin Resistance in Single-Ventricle Physiology: Aspirin Prophylaxis Is Not Adequate to Inhibit Platelets in the Immediate Postoperative Period. Ann Thorac Surg 2015; 99:2158-64. [DOI: 10.1016/j.athoracsur.2015.02.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 01/27/2015] [Accepted: 02/10/2015] [Indexed: 01/19/2023]
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10
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Paikin JS, Hirsh J, Ginsberg JS, Weitz JI, Chan NC, Whitlock RP, Pare G, Johnston M, Eikelboom JW. Multiple daily doses of acetyl-salicylic acid (ASA) overcome reduced platelet response to once-daily ASA after coronary artery bypass graft surgery: a pilot randomized controlled trial. J Thromb Haemost 2015; 13:448-56. [PMID: 25546465 DOI: 10.1111/jth.12832] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 11/30/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND The efficacy of ASA for prevention of graft failure following CABG surgery may be limited by incomplete platelet inhibition due to increased post-operative platelet turnover. OBJECTIVES To determine whether acetyl-salicylic acid (ASA) 325 mg once-daily or 81 mg four-times daily overcomes the impaired response to ASA 81 mg once-daily in post-operative coronary artery bypass graft (CABG) patients. METHODS We randomized 110 patients undergoing CABG surgery to either ASA 81 mg once-daily, 81 mg four times daily or 325 mg once-daily and compared their effects on serum thromboxane B2 (TXB2 ) suppression and arachidonate-induced platelet aggregation. RESULTS One hundred patients were included in the final analysis. Platelet counts fell after surgery, reached a nadir on day 2, and then gradually increased. Although there was near complete suppression of TXB2 on the second or third post-operative day, TXB2 levels increased in parallel with the rise in platelet count on subsequent days. This increase was most marked in patients receiving ASA 81 mg once-daily and less evident in those receiving ASA four times daily. On post-operative day 4, (i) median TXB2 levels were lower with four times daily ASA than with either ASA 81 mg once-daily (1.1 ng/mL; Quartile(Q) Q1,Q3: 0.5, 2.4 and 13.3 ng/mL; Q1,Q3: 7.8, 30.8 ng/mL, respectively; P < 0.0001) or ASA 325 mg once-daily (3.4 ng/mL; Q1,Q3: 2.0, 8.2 ng/mL; P = 0.002), and (ii) ASA given four times daily was more effective than ASA 81 mg once-daily and 325 mg once-daily at suppressing platelet aggregation. CONCLUSIONS Four times daily ASA is more effective than ASA 81 and 325 mg once-daily at suppressing serum TXB2 formation and platelet aggregation immediately following CABG surgery.
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Affiliation(s)
- J S Paikin
- Hamilton General Hospital, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
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11
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Petricevic M, Kopjar T, Gasparovic H, Milicic D, Svetina L, Zdilar B, Boban M, Mihaljevic MZ, Biocina B. Impact of aspirin resistance on outcomes among patients following coronary artery bypass grafting: exploratory analysis from randomized controlled trial (NCT01159639). J Thromb Thrombolysis 2014; 39:522-31. [DOI: 10.1007/s11239-014-1127-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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12
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Plicner D, Ziętkiewicz M, Mazur P, Stąpor R, Sadowski J, Undas A. Beta-thromboglobulin as a marker of perioperative myocardial infarction in patients undergoing coronary artery bypass grafting following aspirin discontinuation. Platelets 2014; 25:603-7. [PMID: 24433129 DOI: 10.3109/09537104.2013.854877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Perioperative myocardial infarction (PMI) following coronary artery bypass grafting (CABG) is associated with significant morbidity and mortality. The aim of this study was to assess platelet activation and oxidative stress in the setting of PMI in patients undergoing CABG. We studied 108 consecutive patients who stopped taking low-dose aspirin 7-10 days prior to elective isolated on- or off-pump CABG. β-thromboglobulin (β-TG), thromboxane B2 (TXB2) and 8-iso-prostaglandin F2α (8-iso-PGF2α), a marker of oxidative stress, were measured at the baseline and 5-7 days postoperatively. Aspirin (150 mg/d) was administered every morning since 12 hours after CABG. Mean baseline β-TG was 58.5 ± 10.3 IU/ml, TXB2 was 143.6 ± 28.5 ng/ml and 8-iso-PGF2α was 355.2 ± 40.7 pg/ml. Postoperatively, after administration of 4-6 doses of aspirin, β-TG increased by 16.7% and 8-iso-PGF2α increased by 17.2% 5-7 days after surgery (p = 0.005 and p < 0.001, respectively). TXB2 decreased by 99.7% to 410.3 ± 52.1 pg/ml (p < 0.001). Nine patients (8.3%) developed PMI. Baseline β-TG and TXB2, together with postoperative β-TG and 8-iso-PGF2α were higher in PMI patients than in the remaining subjects (all, p < 0.05). Multivariate analysis showed that baseline β-TG (OR: 1.28; 95% CI: 1.05-1.57, p = 0.015) was the only independent predictor of PMI. In conclusion, we demonstrated that increased platelet activation and thromboxane production, observed in patients not taking aspirin till the day of CABG, contribute to the occurrence of PMI in early postoperative period.
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Affiliation(s)
- Dariusz Plicner
- Unit of Experimental Cardiac Surgery, Cardiology and Anesthesiology, Institute of Cardiology, Jagiellonian University School of Medicine , Krakow , Poland and
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13
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2012 Update to The Society of Thoracic Surgeons Guideline on Use of Antiplatelet Drugs in Patients Having Cardiac and Noncardiac Operations. Ann Thorac Surg 2012; 94:1761-81. [DOI: 10.1016/j.athoracsur.2012.07.086] [Citation(s) in RCA: 228] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 06/19/2012] [Accepted: 07/10/2012] [Indexed: 12/31/2022]
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14
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Bednar F, Tencer T, Plasil P, Paluch Z, Sadilkova L, Prucha M, Kopa M. Evaluation of Aspirin's Effect on Platelet Function Early After Coronary Artery Bypass Grafting. J Cardiothorac Vasc Anesth 2012; 26:575-80. [DOI: 10.1053/j.jvca.2011.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Indexed: 11/11/2022]
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15
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Li C, Hirsh J, Sloane D, Liang Y, Bai J, Paikin J, Johnston MA, DeBeer J, Eikelboom JW. Aspirin response variability after major orthopedic surgery. Thromb Res 2012; 130:216-20. [DOI: 10.1016/j.thromres.2012.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 03/27/2012] [Accepted: 04/09/2012] [Indexed: 11/16/2022]
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16
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Reilly SJ, Li N, Liska J, Ekström M, Tornvall P. Coronary artery bypass graft surgery up-regulates genes involved in platelet aggregation. J Thromb Haemost 2012; 10:557-63. [PMID: 22329762 DOI: 10.1111/j.1538-7836.2012.04660.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND During and shortly after coronary artery bypass graft (CABG) surgery, there is an increase in thromboembolic events. CABG, a strong inflammatory stimulus, is associated with a hypercoaguable state. Platelets might contribute to this hypercoaguable state because they have a pivotal role in thrombosis. In the days following surgery there is augmented platelet regeneration in response to the inflammatory stimulus. OBJECTIVES The aim of this study was to investigate any changes in platelet mRNA profiles to test the hypothesis that post-CABG surgery platelets are associated with a prothrombotic state. METHODS Blood was sampled and platelets purified from 11 patients before and 3-6 days after CABG. Gene expression profiling was performed using low density array (LDA) plates for seven of the patients. RESULTS Forty-five genes were examined and those significantly up-regulated were glycoprotein (GP)IIb, GPIIIa and cyclooxygenase-1 (COX-1). These findings were confirmed in four more patients, including flow cytometry analysis of the GPIIb/IIIa receptor. CONCLUSIONS CABG surgery up-regulates mRNA and protein levels of proteins that are key players in platelet aggregation. Marked elevation of GPIIb/IIIa mRNA levels results in significantly increased GPIIb/IIIa expression in platelets post-CABG surgery, which may be a reason for increased thrombus formation and myocardial infarction after CABG.
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Affiliation(s)
- S-J Reilly
- Department of Medicine, Atherosclerosis Research Unit, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
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Wang Z, Gao F, Men J, Ren J, Modi P, Wei M. Aspirin resistance in off-pump coronary artery bypass grafting. Eur J Cardiothorac Surg 2012; 41:108-12. [PMID: 21636287 PMCID: PMC3241077 DOI: 10.1016/j.ejcts.2011.04.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 04/06/2011] [Accepted: 04/15/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Anti-platelet therapy with aspirin is the cornerstone of treatment after coronary artery bypass grafting (CABG). Aspirin resistance describes the clinical observation of the inability of aspirin to prevent thrombotic complications or the laboratory phenomenon of absence of the effect of aspirin on platelet inhibition tests. Off-pump CABG (OPCAB) is associated with reduced platelet activation and turnover compared to on-pump surgery which may indicate that aspirin is more effective after OPCAB. Our aim was to evaluate the efficacy of aspirin and incidence of aspirin resistance in patients undergoing OPCAB. METHODS A total of 331 patients was recruited, of which 111 underwent primary OPCAB (group A) and 220 controls with ischaemic heart disease received medical therapy. Arachidonic acid-induced platelet aggregation and urinary 11-dehydro thromboxane B2 (11-dehydroTxB2) were measured at baseline and following aspirin administration on days 1, 4 and 10. A 6-month follow-up was completed in patients who developed aspirin resistance. RESULTS On the first postoperative day, 78 patients (70.3%) were aspirin sensitive (AS) and 33 (29.7%) were aspirin resistant (AR). Of the latter, 18 (16.2%) and five (4.5%) patients remained resistant on days 4 and 10, respectively. AR patients had significantly greater platelet aggregation and urinary 11-dehydroTxB2 levels at all time points than those in the AS group. All patients in the AR group were AS by 6 months. All controls were sensitive to aspirin with similar platelet aggregation and 11-dehydroTxB2 to those in the AS group. CONCLUSIONS Aspirin resistance is a transient phenomenon during the early postoperative period in approximately 30% of patients undergoing OPCAB.
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Affiliation(s)
- Zanxin Wang
- Department of Cardiovascular Surgery, Tianjin Medical University General Hospital, Tianjin, PR China
| | - Fei Gao
- Department of Cardiovascular Surgery, Tianjin Medical University General Hospital, Tianjin, PR China
| | - Jianlong Men
- Department of Clinical Laboratory, Tianjin Medical University General Hospital, Tianjin, PR China
| | - Jing Ren
- Department of Clinical Laboratory, Tianjin Medical University General Hospital, Tianjin, PR China
| | - Paul Modi
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Minxin Wei
- Department of Cardiovascular Surgery, Tianjin Medical University General Hospital, Tianjin, PR China
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Aspirin resistance after coronary artery bypass grafting. COR ET VASA 2010. [DOI: 10.33678/cor.2010.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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