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Reduced Effect of Aspirin and Clopidogrel Following Hybrid Coronary Revascularization
Ivy Susanne Modrau1, Morten Würtz2, Steen Dalby Kristensen2
1Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus, Denmark modrau@mail1.stofanet.dk.
Insights
Hybrid coronary revascularization transiently reduced aspirin and clopidogrel effectiveness. This reduction in antiplatelet therapy effect was not explained by baseline platelet aggregation or postoperative changes.
Area of Science:
- Cardiology
- Vascular Surgery
- Pharmacology
Background:
- Reduced antiplatelet therapy effect post-coronary artery bypass grafting (CABG) is linked to poorer graft patency.
- Understanding antiplatelet response after hybrid coronary revascularization (HCR) is crucial for optimizing outcomes.
Purpose of the Study:
- To evaluate the impact of HCR on aspirin and clopidogrel effectiveness.
- To investigate if baseline platelet aggregation, platelet turnover, or acute-phase response contribute to altered antiplatelet effects post-HCR.
Main Methods:
- Prospective study of 40 patients undergoing elective HCR (off-pump CABG + PCI).
- Assessed platelet aggregation, platelet turnover markers, and acute-phase reactants pre- and post-procedure.
- Dual antiplatelet therapy (aspirin and clopidogrel) was initiated post-PCI.
Main Results:
- Aspirin's antiplatelet effect was reduced early post-op (VerifyNow Aspirin), but not consistently (Multiplate ASPI).
- Clopidogrel's antiplatelet effect was significantly reduced post-PCI (VerifyNow P2Y12, Multiplate ADP).
- No correlation found between baseline aggregation, platelet turnover, acute-phase response, and the observed reduction in antiplatelet effects.
Conclusions:
- HCR led to a transient decrease in aspirin and clopidogrel effectiveness, despite minimally invasive technique.
- The observed reduction in antiplatelet effect was not attributable to baseline platelet aggregation or postoperative inflammatory/turnover markers.
- Further research is needed to elucidate the mechanisms behind this transient reduction in antiplatelet therapy efficacy.
Objective:
Reduced effect of antiplatelet therapy following coronary artery bypass grafting is associated with reduced graft patency. We sought to evaluate the impact of hybrid coronary revascularization on the effect of aspirin and clopidogrel and whether high baseline platelet aggregation, high postoperative levels of platelet turnover, and acute-phase response may contribute to the effect.
Methods:
We prospectively studied platelet aggregation (VerifyNow and Multiplate Analyzer), platelet turnover (immature platelets, mean platelet volume, and thrombopoietin), and acute-phase reactants (C-reactive protein, von Willebrand factor, and coagulation factor VIII) in 40 patients undergoing elective hybrid coronary revascularization (off-pump surgical revascularization through J-hemisternotomy followed by percutaneous coronary intervention [PCI]). Preoperative blood samples on- and off-aspirin were compared with blood samples obtained postoperatively, following PCI when dual antiplatelet therapy had been initiated and at 1-year follow-up.
Results:
The antiplatelet effect of aspirin was significantly reduced in the early postoperative period as measured by VerifyNow Aspirin but not by Multiplate ASPI test. The antiplatelet effect of clopidogrel was significantly reduced following PCI as measured by VerifyNow P2Y12 and Multiplate ADP test. The level of baseline aggregation did not predict the antiplatelet effect of aspirin or clopidogrel, and no association was found between platelet aggregation and postoperative platelet turnover or acute-phase reaction.
Conclusions:
A transient reduction in the antiplatelet effect of aspirin and clopidogrel was observed after hybrid coronary revascularization despite limited surgical trauma and off-pump technique. Neither baseline platelet aggregation nor postoperatively increased platelet turnover and acute-phase response could explain this finding. ClinicalTrials.gov identifier, NCT02293928.
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