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[Antiplatelet therapy after open heart surgery]

H Ohteki1, M Sakai, K Doi

  • 1Department of Cardiovascular Surgery, Saga Prefectural Hospital, Japan.

Kyobu Geka. the Japanese Journal of Thoracic Surgery
|May 1, 1996
PubMed
Summary

This study assessed antiplatelet drugs post-open heart surgery. Aspirin demonstrated antiplatelet effects, with combinations showing enhanced efficacy, while dipyridamole showed no significant antiplatelet activity.

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Area of Science:

  • Cardiovascular Pharmacology
  • Thrombosis and Hemostasis
  • Surgical Patient Care

Background:

  • Post-open heart surgery patients require effective antiplatelet therapy to prevent thrombotic events.
  • Warfarin, dipyridamole, aspirin, ticlopidine, and sarpogrelate hydrochloride are commonly used agents.
  • Evaluating the comparative efficacy of these drugs and their combinations is crucial for optimizing patient outcomes.

Purpose of the Study:

  • To evaluate the antiplatelet effects of dipyridamole, aspirin, ticlopidine, and sarpogrelate hydrochloride in patients following open heart surgery.
  • To compare the efficacy of various combinations of these drugs, including with warfarin.
  • To assess the impact of these agents on specific coagulation and platelet activation markers.

Main Methods:

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  • Patients were divided into six groups receiving different antiplatelet regimens, including warfarin alone or with dipyridamole, aspirin alone or with dipyridamole, and aspirin combined with ticlopidine or sarpogrelate hydrochloride.
  • Coagulation indices (TT, APTT, PT), D-dimer, fibrinogen, thromboxane B2 (TXB2), 6-keto-prostaglandin F1 alpha (6-kPGF1α), beta-thromboglobulin (β-TG), von Willebrand factor (vWF), and platelet aggregation were measured.
  • Platelet aggregation was assessed using Grading Curve methods.

    • Main Results:

    • D-dimer levels were elevated in groups receiving warfarin, indicating potential thrombotic activity.
    • Thromboxane B2 levels were increased with warfarin but reduced with aspirin-based combinations.
    • Platelet aggregation was not suppressed by warfarin or dipyridamole alone; mild to moderate suppression was observed with aspirin alone or with dipyridamole, and moderate to marked suppression was seen with aspirin combined with ticlopidine or sarpogrelate hydrochloride.

    Conclusions:

    • Dipyridamole demonstrated no significant antiplatelet effect in this study.
    • Aspirin exhibited clear antiplatelet activity.
    • Combinations of aspirin with other antiplatelet agents, particularly ticlopidine and sarpogrelate hydrochloride, provided additive antiplatelet effects, suggesting superior efficacy in preventing platelet activation post-surgery.