Original scientific paper
Definition of Acetylsalicylic Acid Resistance Using Whole Blood Impedance Aggregometry in Patients Undergoing Coronary Artery Surgery
Mate Petričević
; University of Zagreb, University Hospital Center Zagreb, Department of Cardiac Surgery, Zagreb, Croatia
Bojan Biočina
; University of Zagreb, University Hospital Center Zagreb, Department of Cardiac Surgery, Zagreb, Croatia
Sanja Konosić
; University of Zagreb, School of Medicine, Department of Anesthesiology, Zagreb, Croati
Ivan Burcar
; University of Zagreb, University Hospital Center Zagreb, Department of Cardiac Surgery, Zagreb, Croatia
Franjo Širić
; University of Zagreb, University Hospital Center Zagreb, Department of Cardiac Surgery, Zagreb, Croatia
Martina Zrno Mihaljević
; University of Zagreb, University Hospital Center Zagreb, Department of Cardiac Surgery, Zagreb, Croatia
Višnja Ivančan
; University of Zagreb, School of Medicine, Department of Anesthesiology, Zagreb, Croatia
Lucija Svetina
; University of Zagreb, University Hospital Center Zagreb, Department of Cardiac Surgery, Zagreb, Croatia
Hrvoje Gašparović
; University of Zagreb, University Hospital Center Zagreb, Department of Cardiac Surgery, Zagreb, Croatia
Abstract
A beneficial effect of acetylsalicylic acid (ASA) on vein graft patency has been described, but some patients experience adverse cardiac events despite appropriate ASA treatment. Study aim was to define ASA resistance using Multiple elec- trode aggregometry (MEA) preoperatively in group of patients undergoing coronary artery bypass grafting (CABG). Pro- spective observational trial at University Hospital Center Zagreb enrolled 131 patients scheduled for CABG, and divided them into 4 groups with respect to preoperative antiplatelet therapy (APT). Group 1 received 100 mg ASA per day, Group 2 100 mg ASA + 75 mg clopidogrel per day, Group 3 75 mg clopidogrel per day, and Group 4 did not receive any APT. MEA with ASPI test (sensitive to ASA) and ADP test (sensitive to clopidogrel) was performed prior to surgery. In Group 1, patients were characterized as ASA resistant if their ASPI test value exceeded the 75 th percentile distribution. Study en- rolled 131 patients. Significant differences both in the ASPI (p<0.001) and the ADP test (p=0.038) were observed be- tween patients in different APT groups. In Group (1) ASPI test value of 30 AUC presented 75 th percentile of distribution, thus indicating ASA resistance. Group 2 patients had slightly lower ADP test values, but no significant difference oc- curred (mean 60.05 vs. 63.32 AUC, p=0.469). In Group 1 and 2, significant correlations between the ADP test and both, platelet count (r=0.347, p<0.001) and fibrinogen level (r=0.364, p<0.001) were observed. Association between low re- sponse to ASA and post-CABG major adverse ischemic events risk increase has been described thus indicating need for ASA resistant patients detection. In patients with preoperative ASPI test exceeding 30 AUC postoperative, ASA dose ad- justment or clopidogrel addition according to MEA results should be considered.
Keywords
multiple electrode aggregometry; aspirin; coronary artery bypass; platelet aggregation; aspirin resistance
Hrčak ID:
118278
URI
Publication date:
30.9.2013.
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