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Published on: March 15, 2022

Response to aspirin and clopidogrel in patients scheduled to undergo cardiovascular surgery

Eli I Lev1, Mahesh Ramchandani, Rajeev Garg

  • 1Department of Cardiology, The Methodist Hospital Research Institute, The Methodist DeBakey Heart Center, Houston, TX 77030, USA.

Journal of Thrombosis and Thrombolysis
|February 6, 2007
PubMed

Insights

Low response to aspirin is linked to poor clopidogrel response in patients undergoing cardiovascular surgery. This suggests a potential need for personalized antiplatelet therapy in this group.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Previous studies linked low platelet response to aspirin with clopidogrel non-response in percutaneous coronary intervention patients.
  • The relationship between aspirin and clopidogrel response in patients undergoing major cardiovascular surgery remained unclear.

Purpose of the Study:

  • To investigate the association between aspirin and clopidogrel response in patients scheduled for cardiac or vascular surgery.
  • To determine if low response to one antiplatelet agent predicts low response to the other in this surgical cohort.

Main Methods:

  • 100 patients scheduled for cardiac/vascular surgery on aspirin and clopidogrel were analyzed.
  • Platelet function was assessed using the modified TEG platelet mapping assay (ADP, AA) and PFA-100 assay (CEPI, CADP).
  • Low response was defined as < or =20% inhibition for TEG-ADP or TEG-AA.

Main Results:

  • 13% of patients were low responders to aspirin and 34% to clopidogrel.
  • Eight patients exhibited low response to both aspirin and clopidogrel.
  • Aspirin low responders showed significantly lower TEG-ADP inhibition (P=0.03) and a trend towards lower PFA-CADP time (P=0.1).
  • Clopidogrel low responders demonstrated significantly lower TEG-AA inhibition (P=0.01) and a trend towards lower PFA-CEPI time (P=0.07).

Conclusions:

  • Low response to aspirin is significantly associated with low response to clopidogrel in patients undergoing cardiovascular surgery.
  • These findings highlight a potential link between antiplatelet drug response across different agents in surgical patients.
  • Further research may explore implications for perioperative antiplatelet management.
Abstract

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