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Published on: March 27, 2018
Postoperative development of aspirin resistance following coronary artery bypass
J Kempfert1, K Anger, A Rastan
1Department of Cardiac Surgery, Heartcenter, University of Leipzig, Leipzig, Germany. kempfert@web.de
Insights
Aspirin resistance is common after coronary artery bypass grafting (CABG) but is transient. While not statistically significant, aspirin resistance may be linked to worse outcomes in CABG patients.
Area of Science:
- Cardiology
- Vascular Surgery
- Pharmacology
Background:
- Aspirin therapy significantly reduces mortality and ischemic complications post-coronary artery bypass grafting (CABG).
- Reported rates of perioperative aspirin resistance reach up to 50%, potentially influenced by extracorporeal circulation.
- Aspirin resistance following CABG may hold significant clinical importance.
Purpose of the Study:
- To investigate the prevalence and clinical relevance of aspirin resistance in patients undergoing CABG.
- To assess the impact of different CABG procedures and preoperative aspirin use on aspirin resistance.
- To evaluate the transient nature of aspirin resistance post-CABG.
Main Methods:
- Investigated aspirin resistance using arachidonic acid-induced platelet aggregometry in 59 patients undergoing various CABG procedures.
- Assessed clinical relevance through a 12-month follow-up period.
- Compared aspirin resistance rates based on preoperative aspirin use and surgical factors like pump time.
Main Results:
- Preoperative resistance was observed in 29% and a postoperative developing resistance in 49% of patients, with only 22% showing normal aspirin response.
- Pre-admission aspirin use significantly reduced resistance rates.
- No significant impact on resistance was found with off-pump surgery or pump times exceeding 120 minutes.
- Three deaths (stroke, intestinal ischemia, mediastinitis) occurred in the perioperative resistance group during 12-month follow-up, versus none in the non-resistant group (P=0.345).
- Perioperative aspirin resistance was not detectable at 12 months in affected patients.
Conclusions:
- Aspirin resistance is a transient phenomenon affecting the majority of patients post-CABG.
- The observed deaths in the resistant group, though not statistically significant, suggest a potential for worse outcomes.
- Further research is warranted to understand and manage perioperative aspirin resistance in CABG patients.
Background:
Aspirin therapy is known to substantially reduce mortality and the rate of ischaemic complications after coronary artery bypass grafting (CABG). Rates of perioperative aspirin resistance cited in the literature are up to 50% and could be influenced by extracorporeal circulation. Thus, aspirin resistance after CABG may have a significant clinical relevance.
Materials And Methods:
In 59 patients undergoing CABG (on-pump, off-pump and combined procedures) aspirin resistance was investigated by arachidonic acid induced platelet aggregometry. Clinical relevance was assessed with 12-month follow up.
Results:
Two types of resistance were observed: A preoperative resistance (despite oral aspirin or in vitro addition) was present in 29% and a postoperative developing type was seen in 49% resulting in only 22% of patients with a 'normal' reaction to aspirin. If patients were already on oral aspirin at admission, the rate of resistance was significantly reduced. Off-pump surgery or pump-times exceeding 120 min had no significant impact on resistance. During the 12-month follow up (98.3%), there were three deaths (one stroke, one intestinal ischaemia, one mediastinitis after postoperative delirium) in patients with the perioperative resistance and none in other patients (P = 0.345). In none of those patients who presented with perioperative aspirin resistance, could this aspirin resistance be demonstrated when tested again after 12 months?
Conclusions:
Aspirin resistance is a transient phenomenon present in the majority of patients undergoing CABG. The three deaths in the resistant group may - although not statistically significant - indicate the possibility of a worse outcome for patients with aspirin resistance.
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