Impaired anti-platelet effect of aspirin, inflammation and platelet turnover in cardiac surgery.
A reduced platelet inhibitory response to acetyl salicylic acid (ASA) has been associated with an increased risk of graft thrombotic occlusion after coronary artery bypass grafting (CABG). We performed a prospective, observational study of 18 patients on 100 mg/day ASA before and after CABG. We assessed antiplatelet response to ASA and its relationship with platelet turnover, inflammatory markers, and soluble thrombomodulin (sTM) levels. All patients showed optimal response to ASA preoperatively but had higher values during follow-up. Platelet aggregation and platelet count in the perioperative period were significantly associated (P=0.05). Platelet turnover was defined as the average daily turnover (ADTO). The lowest inhibitory value (28% of patients > or =6 Omega) was recorded at the same time of the highest platelet turnover (>10% daily in 77.77% of patients), one week after CABG. ADTO >10% was associated with an increased risk of platelet aggregation > or =6 Omega. Levels of sTM were significantly higher one week after CABG (median 13 vs. 3 ng/ml preoperatively, P=0.0011). There is a transient impairment in ASA antiplatelet effect after CABG related to an increased platelet turnover caused by the inflammatory process. This could be responsible for the high risk of occlusive thrombosis.
Arazi
Hernán Cohen
HC
Department of Cardiology, FLENI, Montañeses 2325 (1430), Buenos Aires, Argentina. carazi@fleni.org.ar
Doiny
David G
DG
Torcivia
Ricardo Spampinato
RS
Grancelli
Hugo
H
Waldman
Silvina V
SV
Nojek
Carlos
C
Fornari
María Cecilia
MC
Badimon
Juan Jose
JJ
D000368:Aged; D001241:Aspirin / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D001792:Blood Platelets / Q000187:drug effects*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000209:etiology* / Q000276:immunology; D018836:Inflammation Mediators / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D010974:Platelet Aggregation / Q000187:drug effects*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D010976:Platelet Count; D011446:Prospective Studies; D018180:Thrombomodulin / Q000097:blood; D013927:Thrombosis / Q000097:blood / Q000209:etiology* / Q000276:immunology; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; C508600:IL6 protein, human; D018836:Inflammation Mediators; D015850:Interleukin-6; D010975:Platelet Aggregation Inhibitors; C546931:THBD protein, human; D018180:Thrombomodulin; D001241:Aspirin