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Platelet testing to guide aspirin dose adjustment in pediatric patients after cardiac surgery

Sirisha Emani1, David Zurakowski2, Michelle Mulone3

  • 1Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass.

The Journal of Thoracic and Cardiovascular Surgery
|July 18, 2017
PubMed

Insights

Aspirin resistance in children undergoing cardiac surgery increases thrombosis risk. Adjusting aspirin dosage based on platelet testing significantly reduces this risk, improving patient outcomes.

Area of Science:

  • Cardiology
  • Pediatric Surgery
  • Pharmacology

Background:

  • Thrombosis poses significant risks in pediatric cardiac surgery patients.
  • Aspirin is commonly used for thromboprophylaxis, but its efficacy monitoring is not standardized.
  • Laboratory tests for aspirin efficacy require evaluation in this population.

Purpose of the Study:

  • To assess the relationship between platelet aggregation testing and aspirin dose adjustment.
  • To determine the impact of aspirin responsiveness on thrombosis rates in pediatric cardiac surgery patients.

Main Methods:

  • Retrospective study of pediatric patients undergoing cardiac surgery who received aspirin and platelet testing.
  • Exclusion of patients on multiple agents or with pre-existing thrombosis.
  • Analysis of thrombosis events within 30 days and multivariable logistic regression.

Main Results:

  • 15% of patients showed suboptimal platelet response to aspirin.
  • Aspirin unresponsiveness was a significant risk factor for thrombosis (P < .001).
  • Dose escalation in unresponsive patients significantly reduced thrombosis rates (0/40 vs 9/24, P < .001).

Conclusions:

  • Weight-based aspirin dosing may be insufficient for adequate platelet inhibition in some pediatric patients.
  • Aspirin unresponsiveness is a key risk factor for thrombosis post-pediatric cardiac surgery.
  • Increasing aspirin dosage in unresponsive patients lowers thrombosis risk.
Abstract

Keywords:
aspirincardiac surgerypediatricsplatelet functionthrombosis

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