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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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Aspirin I.V. Loading during Elective Percutaneous Coronary Intervention.

David Naguib1,2, Carolin Helten1,2, Saif Zako1,2

  • 1Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Düsseldorf, Germany.

Pharmacology
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PubMed
Summary

An additional loading dose of acetylsalicylic acid (ASA) during percutaneous coronary interventions (PCI) did not reduce high on-treatment platelet reactivity (HTPR) to aspirin. This pilot study found no significant increase in adverse events or bleeding complications.

Keywords:
Acetylsalicylic acidAspirinElective percutaneous coronary interventionHigh on-treatment platelet reactivityPercutaneous coronary intervention

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Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Percutaneous coronary interventions (PCI) often involve additional acetylsalicylic acid (ASA) loading doses despite ongoing oral ASA therapy.
  • The clinical impact of this practice on platelet reactivity and patient outcomes remains unclear.

Purpose of the Study:

  • To investigate high on-treatment platelet reactivity (HTPR) to aspirin in patients undergoing elective PCI.
  • To compare platelet reactivity and clinical events between patients receiving a peri-procedural ASA loading dose versus those not receiving it.

Main Methods:

  • A pilot study involving 100 patients on chronic low-dose ASA medication undergoing elective PCI.
  • Platelet reactivity was assessed using light-transmission aggregometry, measuring arachidonic acid-induced maximum aggregation (MoA).
  • Patients were divided into groups with and without an additional intravenous ASA loading dose (500 mg).

Main Results:

  • The rate of HTPR (defined as MoA >20%) was similar between the loading dose and control groups (6% vs. 16%).
  • No significant differences in in-hospital major adverse cerebro- and cardiovascular events (MACCEs) were observed between the groups.
  • Thrombolysis in Myocardial Infarction (TIMI) minimal bleeding events were numerically higher in the control group (without ASA loading).

Conclusions:

  • Peri-procedural ASA loading did not effectively reduce HTPR in patients on chronic low-dose ASA undergoing PCI.
  • The additional ASA loading dose did not increase in-hospital MACCEs or bleeding complications in this pilot study.