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Published on: June 5, 2019
Platelet hyperreactivity after coronary artery bypass grafting: the possible relevance to glycoprotein polymorphisms.
J Golanski1, R Golanski, K Chizynski
1Laboratory of Haemostasis and Haemostatic Disorders, Medical University of Lódz, Poland.
Insights
Coronary artery bypass grafting (CABG) surgery temporarily reduces platelet reactivity, which then rebounds significantly by 7 days post-operation. This platelet hyperreactivity is linked to specific genetic variations and may predict complications in CABG patients.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Genetics
Background:
- Coronary artery bypass grafting (CABG) surgery significantly impacts platelet function and reactivity.
- Individual patient responses to CABG surgery show considerable variability, potentially due to platelet glycoprotein polymorphisms.
Purpose of the Study:
- To investigate the association between platelet reactivity and its restoration post-CABG.
- To explore the link between platelet functional response and genetic polymorphisms of platelet membrane glycoproteins.
Main Methods:
- Whole blood impedance aggregometry and platelet function analyser (PFA-100) were used to monitor platelet reactivity in 32 ischemic heart disease patients.
- Measurements were taken at four intervals: pre-operation, 2 hours post-protamine sulfate, 3 days post-CABG, and 7 days post-CABG.
Main Results:
- Platelet reactivity decreased 2 hours post-CABG but significantly increased by 7 days post-operation.
- Prothrombotic phenotype variants of platelet membrane glycoproteins were more frequent in patients with higher platelet reactivity.
- Restored platelet hyperreactivity post-CABG was more common in patients experiencing postoperative myocardial ischemic episodes, associated with the GPIa (807)T allele.
Conclusions:
- A rapid restoration of hemostatic capacity and platelet hyperreactivity occurs by 7 days post-CABG, particularly in patients with ischemic episodes.
- Platelet hyperfunction post-CABG is associated with GPIa (807)C/T and GPIIIa PlA(1/A2) polymorphisms.
- These findings may be crucial for predicting postoperative vascular complications in CABG patients.
Abstract:
Coronary artery bypass grafting (CABG) surgery impairs platelet function and reactivity to a considerable extent. However, variability in the individual patients' responses makes any generalised statement uncertain. The observed variability is nowadays thought to relate to platelet glycoprotein polymorphisms. Our objective was to investigate the association between platelet reactivity and the restoration of platelet functional response to agonists during the period following cardiosurgical operation and some genetic polymorphisms of selected platelet membrane glycoproteins. Platelet reactivity was monitored in 32 IHD patients (56 +/- 8 years) subjected to CABG surgery by means of whole blood impedance aggregometry and concurrently using the platelet function analyser (PFA-100 at four time intervals: prior to operation (A), 2 h after administration of protamine sulfate (B), 3 days after (C) and 7 days after CABG surgery (D). Three important findings were made. First, in all patients platelet reactivity became decreased 2 h postoperatively (aggregation with 20 microM ADP reduced by up to 49%, P < 0.02) and vastly increased 7 days after CABG surgery (CT(CADP) reduced down to 87% of initial value, P < 0.05, ADP-induced aggregation enhanced up to 167%, P < 0.001, and that with collagen up to 131% of the initial value, P < 0.01). Second, the frequencies of the 'prothrombotic' phenotype variants of platelet membrane glycoproteins were higher in patients referred to as the carriers of more reactive platelets compared to those with less reactive platelets (GPIa (807)T-positive, 50 vs. 28%; GPIIIa Pl(A2)-positive, 27 vs. 21%; GPIb Met(145)-positive and GPIb VNTR B-positive, 13 vs. 0%. Lastly, the restoration in platelet hyperreactivity in CABG surgery patients was recorded more often in patients who underwent postoperative myocardial ischaemic episode(s), and was associated with significantly higher frequency of the 'prothrombotic' allele (807)T of the collagen receptor glycoprotein Ia (GPIa) in these subjects (83 vs. 61%). In conclusion, in patients with ischaemic episodes after CABG, we demonstrated a fast postoperative restoration of haemostatic capacity and evidence of platelet hyperreactivity at 7 days after CABG surgery. The platelet hyperfunction seems to relate to the occurrence of platelet glycoprotein polymorphisms GPIa(807)C/T and GPIIIa PlA(1/A2) and may be important in predicting postoperative vascular complications in CABG patients.
