Aspirin Resistance after CABG

Abstract

Background: Temporary aspirin resistance can occur during the post-CABG period. If the factors causing resistance can be identified, the incidence of early graft occlusions can also be minimized. Methods: 25 elective CABG cases were enrolled in the study. The platelet count, mean platelet volume, the C-reactive protein level, lipid profile, blood urea nitrogen (BUN), and creatinine levels were identified one day before the operation and on the 1st, 5th and 10th postoperative days. Optical aggregometry was used for the evaluation of aspirin response. The patients were divided into two groups: those with aspirin resistance and those with no aspirin resistance. Results: The rate of postoperative aspirin resistance was found to be 60 %. No significant difference was found when the preoperative and operative data of the two groups were compared. It was found that the rapid changes observed in the postoperative platelet counts and the C-reactive protein levels were similar. Conclusion: Aspirin resistance is encountered during the early postoperative period in the majority of patients undergoing CABG. None of the factors studied were found to be causative for resistance formation. Further studies are required to clarify this entity.

Key words

coronary bypass surgery - cardiovascular surgery - aspirin resistance

References

• 1 Eagle K A, Guyton R A, Davidoff R et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery).  Circulation. 2004;  110 (14) e340-437
• 2 Zimmermann N, Kienzle P, Weber A A et al. Aspirin resistance after coronary artery bypass grafting.  J Thorac Cardiovasc Surg. 2001;  121 982-984
• 3 Zimmermann N, Wenk A, Kim U et al. Functional and biochemical evaluation of platelet aspirin resistance after coronary artery bypass surgery.  Circulation. 2003;  108 542-547
• 4 Zimmermann N, Kurt M, Wenk A, Winter J, Gams E, Hohlfeld T. Is cardiopulmonary bypass a reason for aspirin resistance after coronary artery bypass grafting?.  Eur J Cardiothorac Surg. 2005;  27 (4) 606-610
• 5 Golański J, Chłopicki S, Golański R, Gresner P, Iwaszkiewicz A, Watala C. Resistance to aspirin in patients after coronary artery bypass grafting is transient: impact on the monitoring of aspirin antiplatelet therapy.  Ther Drug Monit. 2005;  27 (4) 484-490
• 6 Poston R S, Gu J, White C et al. Perioperative management of aspirin resistance after off-pump coronary artery bypass grafting: possible role for aprotinin.  Transfusion. 2008;  48 (Suppl. 1) 39S-46S
• 7 Poston R S, Gu J, Brown J M et al. Endothelial injury and acquired aspirin resistance as promoters of regional thrombin formation and early vein graft failure after coronary artery bypass grafting.  J Thorac Cardiovasc Surg. 2006;  131(1) 122-130
• 8 Gum P A, Kottke-Marchant K, Welsch P A, White J, Topol E J. A prospective, blinded determination of the natural history of aspirin resistance among stable patients with cardiovascular disease.  J Am Coll Cardiol. 2003;  41 961-965
• 9 Grotemeyer K H, Scharafinski H W, Husstedt I W. Two-year follow up of aspirin responders and aspirin non-responders. A pilot study including 180 post-stroke patients.  Thromb Res. 1993;  71 397-403
• 10 Mueller M R, Salat A, Stangl P, Murabito M, Pulaki S, Boehm D. Variable platelet response to low dose ASA and the risk of limb deterioration in patients submitted to peripheral arterial angioplasty.  Thromb Haemost. 1997;  78 1003-1007
• 11 Eikelboom J W, Hirsh J, Weitz J I et al. Aspirin-resistant thromboxane biosynthesis and the risk of myocardial infarction, stroke, or cardiovascular death in patients at high risk for cardiovascular events.  Circulation. 2002;  105 1650-1655
• 12 Tetik S, Eksioglu-Demiralp E, Yardimci K T. Effect of imatinib mesylate on platelet aggregation and fibrinogen binding to isolated platelets.  Adv Mol Med. 2005;  1(4) 165-170
• 13 Szczeklik A, Musiał J, Undas A, Sanak M, Nizankowski R. Aspirin resistance.  Pharmacol Rep. 2005;  57 (Suppl.) 33-41
• 14 Yilmaz M B, Balbay Y, Korkmaz S. Aspirin resistance.  Anadolu Kardiyol Derg. 2004;  4 (1) 59-62
• 15 Weber A A, Zimmermann K C, Meyer-Kirchrath J, Schor K. Cyclooxygenase-2 in human platelets as a possible factor in aspirin resistance (letter).  Lancet. 1999;  353 900
• 16 Tabakan A, Sokullu O, Sanioğlu S et al. Evaluation of the inflammatory response in coronary artery surgery: comparison of extracorporeal circulation and beating heart techniques.  Turkish J Thorac Cardiovasc Surg. 2006;  14 (1) 24-28
• 17 Khan T A, Bianchi C, Voisine P et al. Reduction of myocardial reperfusion injury by aprotinin after regional ischemia and cardioplegic arrest.  J Thorac Cardiovasc Surg. 2004;  128 (4) 602-608