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Blood loss after coronary artery bypass by aspirin responsiveness assessed with preoperative VerifyNow aspirin

Laura M Willemsen1, Eline A Vlot2, Paul W A Janssen1

  • 1Department of Cardiology St Antonius Hospital Nieuwegein The Netherlands.

Research and Practice in Thrombosis and Haemostasis
|January 7, 2022
PubMed

Insights

Aspirin sensitivity in patients undergoing coronary artery bypass grafting (CABG) is linked to increased blood loss. Preoperative testing can identify those at higher risk for bleeding complications after CABG surgery.

Area of Science:

  • Cardiology
  • Hematology
  • Surgical Research

Background:

  • Aspirin is crucial for preventing thrombotic events but elevates bleeding risks.
  • Managing bleeding while ensuring thrombotic event prevention is challenging in coronary artery bypass grafting (CABG) patients.
  • Preoperative assessment of aspirin response may identify patients susceptible to perioperative blood loss.

Purpose of the Study:

  • To compare 12-hour blood loss following CABG between aspirin-sensitive and aspirin-resistant patient groups.
  • To evaluate the utility of preoperative aspirin response testing in predicting bleeding risk in CABG patients.

Main Methods:

  • A substudy of the POPular CABG trial included patients on preoperative aspirin monotherapy.
  • A preoperative VerifyNow aspirin assay determined aspirin sensitivity/resistance based on a cutoff of 550 aspirin reaction units.
  • Primary endpoint was 12-hour postoperative blood loss; secondary endpoint included clinical bleeding events.

Main Results:

  • 128 patients were analyzed: 116 aspirin-sensitive and 12 aspirin-resistant.
  • Mean 12-hour blood loss was significantly higher in aspirin-sensitive patients (555 ± 278 mL) compared to aspirin-resistant patients (406 ± 110 mL) (P = .04).
  • All 15 clinical bleeding events (11.7%) occurred in the aspirin-sensitive group.

Conclusions:

  • Preoperative aspirin sensitivity is associated with increased 12-hour blood loss after CABG.
  • VerifyNow aspirin testing can potentially identify CABG patients at high risk for perioperative bleeding.
  • This testing may aid in personalized risk assessment and management strategies for CABG patients on aspirin.
Abstract

Keywords:
aspirinblood loss, surgicalcardiovascular surgical procedurescoronary artery bypassplatelet function tests

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