title: The role of unfractionated heparin for the antiaggregatory effect of aspirin in patients undergoing carotid endarterectomy: Results of an observational clinical study.
abstract: The aims of the present study were to examine the influence of a low-dose unfractionated heparin regime on platelet aggregation and to additionally assess the prevalence of primary aspirin resistance in patients undergoing carotid endarterectomy. Therefore, 50 patients undergoing carotid endarterectomy were enrolled. A bolus of 3000 IU unfractionated heparin was administered 2 min before carotid cross-clamping additionally to standard antiaggregatory therapy. Haemostaseological point of care testing was performed twice, prior to surgery and 10 min after unfractionated heparin administration by the use of aggregometric and viscoelastic point of care testing. Following unfractionated heparin administration, the activated partial thromboplastin time increased significantly and clotting time in viscoelastic INTEM test was shown to be significantly prolonged. In contrast, the antiaggregatory effect of aspirin was not diminished in aggregometric ASPI test. A low-dose unfractionated heparin regime during carotid endarterectomy was therefore considered to be safe, without diminishing the antiplatelet effect of aspirin. Moreover, aggregometric point of care testing was identified to be a suitable tool for the identification of patients with primary aspirin resistance ( n = 3).
authors.affiliation: 1 Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Brenner
authors.affiliation: 1 Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Felix Cf
authors.initials: FC
authors.lastname: Schmitt
authors.affiliation: 2 Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Serdar
authors.initials: S
authors.lastname: Demirel
authors.affiliation: 1 Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Salgado
authors.affiliation: 2 Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Juan Antonio
authors.initials: JA
authors.lastname: Celi de la Torre
authors.affiliation: 1 Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Göring
authors.affiliation: 3 Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bruckner
authors.affiliation: 2 Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Dittmar
authors.initials: D
authors.lastname: Böckler
authors.affiliation: 1 Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Markus A
authors.initials: MA
authors.lastname: Weigand
authors.affiliation: 1 Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Hofer
authors.affiliation: 2 Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Attigah
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000187:drug effects*; D001780:Blood Coagulation Tests; D002340:Carotid Artery Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000601:surgery*; D004351:Drug Resistance; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D005260:Female; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010974:Platelet Aggregation / Q000187:drug effects*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D010979:Platelet Function Tests; D000067716:Point-of-Care Testing; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D006493:Heparin; D001241:Aspirin
keywords: Carotid endarterectomy; aspirin resistance; point of care testing; unfractionated heparin