title: The Prevalence and Clinical Relevance of ASA Nonresponse After Cardiac Surgery: A Prospective Bicentric Study.
abstract: We aimed to identify the prevalence of acetylsalicylic acid (ASA) nonresponse in patients after coronary artery bypass graft (CABG) surgery and the possible consequences for the rate of major cardiovascular events. This prospective, observational, bicentric cohort study was conducted in two German University hospitals. A total of 400 patients (200 in each study center) undergoing elective CABG surgery were enrolled after written informed consent. Platelet function was analyzed on day 3 (d3) and day 5 (d5) postoperatively following stimulation with arachidonic acid (ASPItest) and with thrombin receptor-activating peptide 6 (TRAPtest) using multiple electrode aggregometry (Multiplate). Individuals with an ASPItest ≥40 AU·min were categorized as ASA nonresponders. A 1-year follow-up recorded the combined end point of cardiovascular events, hospital admissions, or deaths related to cardiovascular disease. The prevalence of ASA nonresponse was 51.5% on d3, and it significantly increased to 71.3% on d5 ( P = .0049). The area under the aggregation curve in the TRAPtest ( P < .0001), the platelet count on d5 ( P = .009), and the cardiopulmonary bypass time ( P = .01) were identified as independent predictors of an ASA nonresponse. A 1-year follow-up recorded 54 events fulfilling criteria for the combined end point with no difference between ASA responders and nonresponders. This study indicates a high incidence of perioperative ASA nonresponse in patients following CABG. No effect on the incidence of cardiovascular events was recorded in the 1-year follow-up. Therefore, a randomized dosage adjustment trial should elucidate whether a tailored ASA treatment after CABG surgery represents a useful concept.
authors.affiliation: 1 Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany.
authors.forename: Saskia
authors.initials: S
authors.lastname: Wand
authors.affiliation: 2 Department of Anesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany.
authors.forename: Elisabeth Hannah
authors.initials: EH
authors.lastname: Adam
authors.affiliation: 1 Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany.
authors.forename: Anna Julienne
authors.initials: AJ
authors.lastname: Wetz
authors.affiliation: 2 Department of Anesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany.
authors.forename: Patrick
authors.initials: P
authors.lastname: Meybohm
authors.affiliation: 1 Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany.
authors.forename: Nils
authors.initials: N
authors.lastname: Kunze-Szikszay
authors.affiliation: 2 Department of Anesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany.
authors.forename: Kai
authors.initials: K
authors.lastname: Zacharowski
authors.affiliation: 3 Department of Thoracic and Cardiovascular Surgery, University Medical Center Göttingen, Göttingen, Germany.|4 Department for Cardiothoracic and Vascular Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany.
authors.forename: Aron Frederick
authors.initials: AF
authors.lastname: Popov
authors.affiliation: 4 Department for Cardiothoracic and Vascular Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany.
authors.forename: Anton
authors.initials: A
authors.lastname: Moritz
authors.affiliation: 1 Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany.
authors.forename: Lisa
authors.initials: L
authors.lastname: Moldenhauer
authors.affiliation: 2 Department of Anesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Kaiser
authors.affiliation: 1 Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Bauer
authors.affiliation: 1 Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany.
authors.forename: Christian Friedrich
authors.initials: CF
authors.lastname: Weber
mesh_terms: D000368:Aged; D001241:Aspirin / Q000008:administration & dosage*; D001026:Coronary Artery Bypass; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010979:Platelet Function Tests; D015995:Prevalence; D011446:Prospective Studies
chemical_list: D001241:Aspirin
keywords: ASA nonresponse; cardiac surgery; multiple electrode aggregometry; platelet function