Thorac Cardiovasc Surg 2011; 59(7): 425-429
DOI: 10.1055/s-0030-1270711
Original Basic Science

© Georg Thieme Verlag KG Stuttgart · New York

Functional Evaluation of Platelet Aspirin Resistance after On-Pump Coronary Bypass Grafting Using Multiple Aggregation Tests

I. Kammerer1 , J. Bach2 , W. Saggau1 , F. Isgro1
  • 1Department of Cardiac Surgery, Academic City Hospital Ludwigshafen, Ludwigshafen, Germany
  • 2Institute of Hemostaseology and Transfusion Medicine, Academic City Hospital Ludwigshafen, Ludwigshafen, Germany
Further Information

Publication History

received July 11, 2010

Publication Date:
24 March 2011 (online)

Abstract

Object: The predominant mechanism of early graft failure after coronary artery bypass grafting (CABG) is associated with antiplatelet treatment using drugs such as acetylsalicylic acid (ASA). Impaired hemostasis of multiple etiologies is often present in patients undergoing on-pump cardiac surgery. We investigated the impact of intravenous ASA administration on platelet function in this setting. Methods: Forty-two patients were enrolled in the study. Patients received 100 mg oral ASA once daily, beginning in the early postoperative period. Noncompliance was eliminated by the administration of 300 mg ASA intravenously at 6–8 days post-operation. Blood was drawn immediately before, 1 h and 24 h after ASA administration. Results: A platelet function analyzer (PFA-100™) was used to evaluate closure time (CT), turbidimetric platelet aggregation (TPA) and impedance platelet aggregation (IPA) induced by arachidonic acid (AA), collagen and ADP and results were compared with the respective values from 120 healthy individuals. At 1 h and 24 h after administration, we found that intravenous ASA caused CEPI-CT to be significantly prolonged with a reduction of AA and collagen-induced IPA. Despite postoperative oral ASA administration for 6–8 days, PFA-100™ CEPI and CADP-CT were significantly shorter and ADP-TPA and IPA values induced by any agonist were significantly greater in patients than in controls. Intravenous ASA had no significant influence on CADP-CT or ADP-induced IPA (ADP-IPA). Conclusion: Platelet tests for diagnosing patients as aspirin responders (ASA-R) or aspirin non-responders (ASA-NR) were found to be not comparable. Patients after CABG show augmented platelet dysfunction. Intravenous ASA administration may indicate a promising approach to reduce laboratory resistance after CABG procedure. The reason for this is not clear and requires additional clinical studies.

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Dr. Inna Kammerer

Department of Cardiac Surgery
Academic City Hospital Ludwigshafen

Bremserstr. 79

67063 Ludwigshafen

Germany

Email: kammerei@klilu.de