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Increased plasma beta-thromboglobulin in patients with coronary artery vein graft occlusion: response to low dose
T P Gavaghan1, J B Hickie, S A Krilis
1Department of Cardiology, St. Vincent's Hospital, Sydney, New South Wales, Australia.
Insights
Aspirin significantly reduces vein graft occlusion after coronary artery bypass surgery by lowering platelet activation, as indicated by beta-thromboglobulin levels. This finding highlights aspirin
Area of Science:
- Cardiovascular Surgery
- Pharmacology
- Hematology
Background:
- Platelet activation, indicated by elevated plasma beta-thromboglobulin, is observed in patients with coronary artery disease.
- Vein graft occlusion is a significant complication following coronary artery bypass graft (CABG) surgery.
Purpose of the Study:
- To investigate the therapeutic effect of aspirin on vein graft patency in CABG patients.
- To evaluate the relationship between platelet activation (beta-thromboglobulin) and subsequent vein graft occlusion.
Main Methods:
- 105 patients undergoing CABG were randomized to receive aspirin (324 mg/day) or placebo post-surgery.
- Serial plasma beta-thromboglobulin levels were measured preoperatively and at 3 and 12 months post-surgery.
- Graft patency was assessed angiographically at 1 week and 1 year, with occlusion rates compared between groups.
Main Results:
- Aspirin treatment significantly reduced graft occlusion rates (12.5%) compared to placebo (34.7%) (p < 0.01).
- Preoperative beta-thromboglobulin levels were significantly higher in surgical patients than controls (p < 0.004).
- Higher preoperative beta-thromboglobulin levels were associated with increased graft occlusion (p < 0.02), and aspirin effectively prevented occlusion.
Conclusions:
- Elevated plasma beta-thromboglobulin indicates ongoing platelet activation in patients with coronary artery disease.
- Aspirin therapy is effective in preventing vein graft occlusion post-CABG, particularly in patients with elevated preoperative platelet activation.
- Beta-thromboglobulin levels can serve as a predictive marker for vein graft occlusion in CABG patients.
Abstract:
The therapeutic effect of aspirin on vein graft patency was studied in patients undergoing coronary artery bypass graft surgery. The study design enabled the prospective evaluation of the relation of platelet activation, as measured by plasma beta-thromboglobulin concentration, to subsequent coronary vein graft occlusion. Serial beta-thromboglobulin levels were measured in 105 patients randomized to receive aspirin (324 mg/day) or placebo beginning within 1 h after surgery. Graft patency was assessed angiographically at 1 week and 1 year after surgery. Of 49 patients receiving placebo, 17 (34.7%) had one or more graft occlusions, 6 early, 10 late and 1 with both early and late occlusion. Of 56 patients receiving aspirin, 7 (12.5%) had one or more occlusions, 3 early and 4 late (p less than 0.01). Preoperatively, the beta-thromboglobulin level in surgical patients (29 +/- 13.5 ng/ml) was significantly higher than that of 51 control subjects (22.6 +/- 11.1 ng/ml) (p less than 0.004). Plasma beta-thromboglobulin levels remained comparatively constant at 3 and 12 months after surgery in the 43 patients who had both samples available (p less than 0.001, r = 0.65). The reduction in beta-thromboglobulin concentration from the preoperative level to 12 months postoperatively was greater in the aspirin-treated group (p less than 0.001). Multivariate logistic regression analysis demonstrated a significant association between preoperative beta-thromboglobulin concentration and graft occlusion (p less than 0.02), and aspirin treatment was effective in preventing occlusion when adjusted for the preoperative beta-thromboglobulin level (p less than 0.005). Plasma beta-thromboglobulin concentrations are elevated in patients with coronary artery disease, suggesting ongoing platelet activation.(ABSTRACT TRUNCATED AT 250 WORDS)