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Vol 13, No 5 (2018)
Original Papers
Published online: 2018-12-06
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Effect of low-dose acetylsalicylic acid on perioperative platelet reactivity in patients undergoing off-pump coronary artery bypass grafting

Radosław Wilimski, Zenon Huczek, Agnieszka Kondracka, Hanna Zborowska, Mateusz Wondołkowski, Anna Wancerz, Dominika Puchta, Wiktoria Ciechowska, Piotr Hendzel, Romuald Cichoń
DOI: 10.5603/FC.2018.0111
·
Folia Cardiologica 2018;13(5):407-415.

open access

Vol 13, No 5 (2018)
Original Papers
Published online: 2018-12-06

Abstract

Introduction. Acetylsalicylic acid (ASA) is the antiplatelet drug most used in the perioperative period in patients undergoing coronary artery bypass grafting (CABG). Off-pump coronary artery bypass grafting (OPCAB) is likely to alter platelet (PLT) function to a lesser extent than CABG with the use of cardiopulmonary bypass and may potentially result in high on-aspirin platelet reactivity (HAPR) in the postoperative period. Materials and methods. The aim of this prospective study was to characterise serum thromboxane B2 (TXB2) variability and ASA-dependent platelet reactivity in patients with stable coronary artery disease undergoing OPCAB treated with a single daily dose of 75 mg of ASA. Blood sampling was performed 2 hours and 24 hours after ASA intake on the day before surgery, and on the 2nd and 7th days after the operation. Results. A PLT counts reduction and a mean platelet volume increase were observed on the 2nd day after OPCAB. A PLT counts increase was found on the 7th postoperative day. A significant increase (p = 0.03) in the percentage of patients with insufficient laboratory ASA efficacy (defined by serum TXB2 ≥ 7.2 ng/mL) was observed on the 7th postoperative day compared to preoperative values (52% vs 20% respectively, p = 0.02). A significant increase in median platelet reactivity and in the percentage of patients with HAPR (defined by VerifyNow® Aspirin test result ≥ 550 ARU) was observed on the 7th postoperative day in comparison with the values before OPCAB (48% vs 12%, p = 0.007). Conclusions. In the group of patients taking a standard daily dose of 75 mg of ASA, a substantial number of patients failed to attain optimal inhibition of serum TXB2 or had HAPR before surgery and on the 7th day after OPCAB. A significant decrease in serum TXB2 levels on the 2nd day after OPCAB did not correlate with PLT reactivity. The optimal dose of ASA is of interest for further studies of efficacy and clinical outcomes after OPCAB.

Abstract

Introduction. Acetylsalicylic acid (ASA) is the antiplatelet drug most used in the perioperative period in patients undergoing coronary artery bypass grafting (CABG). Off-pump coronary artery bypass grafting (OPCAB) is likely to alter platelet (PLT) function to a lesser extent than CABG with the use of cardiopulmonary bypass and may potentially result in high on-aspirin platelet reactivity (HAPR) in the postoperative period. Materials and methods. The aim of this prospective study was to characterise serum thromboxane B2 (TXB2) variability and ASA-dependent platelet reactivity in patients with stable coronary artery disease undergoing OPCAB treated with a single daily dose of 75 mg of ASA. Blood sampling was performed 2 hours and 24 hours after ASA intake on the day before surgery, and on the 2nd and 7th days after the operation. Results. A PLT counts reduction and a mean platelet volume increase were observed on the 2nd day after OPCAB. A PLT counts increase was found on the 7th postoperative day. A significant increase (p = 0.03) in the percentage of patients with insufficient laboratory ASA efficacy (defined by serum TXB2 ≥ 7.2 ng/mL) was observed on the 7th postoperative day compared to preoperative values (52% vs 20% respectively, p = 0.02). A significant increase in median platelet reactivity and in the percentage of patients with HAPR (defined by VerifyNow® Aspirin test result ≥ 550 ARU) was observed on the 7th postoperative day in comparison with the values before OPCAB (48% vs 12%, p = 0.007). Conclusions. In the group of patients taking a standard daily dose of 75 mg of ASA, a substantial number of patients failed to attain optimal inhibition of serum TXB2 or had HAPR before surgery and on the 7th day after OPCAB. A significant decrease in serum TXB2 levels on the 2nd day after OPCAB did not correlate with PLT reactivity. The optimal dose of ASA is of interest for further studies of efficacy and clinical outcomes after OPCAB.
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Keywords

acetylsalicylic acid, coronary artery bypass grafting, thromboxane, platelet reactivit

About this article
Title

Effect of low-dose acetylsalicylic acid on perioperative platelet reactivity in patients undergoing off-pump coronary artery bypass grafting

Journal

Folia Cardiologica

Issue

Vol 13, No 5 (2018)

Pages

407-415

Published online

2018-12-06

DOI

10.5603/FC.2018.0111

Bibliographic record

Folia Cardiologica 2018;13(5):407-415.

Keywords

acetylsalicylic acid
coronary artery bypass grafting
thromboxane
platelet reactivit

Authors

Radosław Wilimski
Zenon Huczek
Agnieszka Kondracka
Hanna Zborowska
Mateusz Wondołkowski
Anna Wancerz
Dominika Puchta
Wiktoria Ciechowska
Piotr Hendzel
Romuald Cichoń

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