PDF herunterladen
Thromb Haemost 1997; 78(03): 1003-1007
DOI: 10.1055/s-0038-1657677
Rapid Communication
Schattauer GmbH Stuttgart

Variable Platelet Response to Low-dose ASA and the Risk of Limb Deterioration in Patients Submitted to Peripheral Arterial Angioplasty

Michael Rolf Mueller
1   The University of Vienna, Department of Cardio-Thoracic Surgery, Vienna, Austria
,
Andreas Salat
2   The University of Vienna, Department of General Surgery, Vienna, Austria
,
Petra Stangl
2   The University of Vienna, Department of General Surgery, Vienna, Austria
,
Marco Murabito
3   The University of Vienna, Department of Center f. Biomedical Research and LBI f. Cardio-Surgical Research, Vienna, Austria
,
Sad Pulaki
3   The University of Vienna, Department of Center f. Biomedical Research and LBI f. Cardio-Surgical Research, Vienna, Austria
,
Dagmar Boehm
4   The University of Vienna, Department of Clinic of Anesthesiology and General Intensive Care Medicine, Vienna, Austria
,
Renate Koppensteiner
5   The University of Vienna, Department of Angiology, Vienna, Austria
,
Erdem Ergun
6   The University of Vienna, Department of Clinic of Ophtalmology, Vienna, Austria
,
Martina Mittlboeck
7   The University of Vienna, Institute of Medical Computer Science, Vienna, Austria
,
Wolfgang Schreiner
7   The University of Vienna, Institute of Medical Computer Science, Vienna, Austria
,
Udo Losert
3   The University of Vienna, Department of Center f. Biomedical Research and LBI f. Cardio-Surgical Research, Vienna, Austria
,
Ernst Wolner
1   The University of Vienna, Department of Cardio-Thoracic Surgery, Vienna, Austria
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Received 10. 1997

Accepted after resubmission 13. Mai 1997

Publikationsdatum:
12. Juli 2018 (online)

Auch verfügbar auf
  als PDF herunterladen  Lizenzen und Reprints

Summary

A group of 100 patients with intermittent claudication (70 male, 30 female), treated with 100 mg ASA per day, were followed over 18 months after elective percutaneous balloon angioplasty. Platelet function was monitored over a period of 12 months by corrected whole blood aggregometry (CWBA). Upon stimulation by arachidonic acid (AA), adenosine diphosphate (ADP) and collagen, CWBA-results were obtained by an electronic acquisition and evaluation system correcting for hematocrit and platelet count of the blood sample.

All patients showed a completely inhibited platelet response to AA stimulation. Comparison of the CWB A-results with clinical parameters revealed that reocclusions at the site of angioplasty occurred exclusively in male patients for which CWBA failed to prove an inhibition of aggregation upon both agonists, ADP and collagen, and for these patients the risk of complication is at least 87% higher (p = 0.0093).

Only 40% of male patients show the expected effect of ASA on in vitro platelet aggregation at any given point in time and CWBA is capable of predicting those male patients which are at an elevated risk of reocclusion following peripheral angioplasty.

 

  • References

  • 1 Ridker PM, Manson JE, Buring JE, Muller JE, Hennekens CH. Circadian Variation of Acute Myocardial Infarction and the Effect of Low-Dose Aspirin in a Randomized Trial of Physicians. Circulation 1990; 82: 897-902
    CrossrefPubMedGoogle Scholar
  • 2 Lorenz RL, Schacky CV, Weber M, Meister W, Kotzur J, Reichardt B, Theisen K, Weber PC. Improved aortocoronary bypass patency by lowdose aspirin (100 mg daily). Effects on platelet aggregation and thromboxane formation. Lancet 1984; 01 (8389) 1261-1264
    PubMedGoogle Scholar
  • 3 Stein B, Fuster V, Israel DH, Cohen M, Badimon L, Badimon JJ, Chesebro JH. Platelet inhibitor agents in cardiovascular disease: an update. J Am Coll Cardiol 1989; 14 (04) 813-836
    CrossrefPubMedGoogle Scholar
  • 4 Husted SE, Kraemmer-Nielsen H, Krusell LR, Faergeman O. Acetylsalicylic acid 100 mg and 1000 mg daily in acute myocardial infarction suspects: a placebo-controlled trial. J Intern Med 1989; 226 (05) 303-310
    CrossrefPubMedGoogle Scholar
  • 5 Lewis HD, Davis JW, Archibald DG. Protective effects of Aspirin against acute myocardial infarction and death in men with unstable angina: Results of a Veterans Administration Cooperative Study. N Engl J Med 1983; 309: 396-403
    CrossrefPubMedGoogle Scholar
  • 6 Steering Committee of the Physicians’ Health Study Research Group: Final report on the aspirin component of the ongoing physicians’ health study. N Engl J Med 1989; 321: 125-129
    PubMed
  • 7 Antiplatelet Trialists’ Collaboration: Collaborative overview of randomised trials of antiplatelet therapy-I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ 1994; 308 (6921) 081-106
    CrossrefPubMed
  • 8 Antiplatelet Trialists’ Collaboration: Collaborative overview of randomised trials of antiplatelet therapy-II: Maintenance of vascular graft or arterial patency by antiplatelet therapy. BMJ 1994; 308 (6922) 159-168
    CrossrefPubMed
  • 9 Misselwitz F, Norden C, Heine H. Individually controlled aspirin in the long-term treatment of patients with chronic arterial diseases. Angiology 1989; 40 (05) 464-471
    CrossrefPubMedGoogle Scholar
  • 10 Cerletti C, Latini R, Del MaschioA, Galletti F, Dejana E, de Gaetano g. Aspirin kinetics and inhibition of platelet thromboxane generationrelevance for a solution of the “aspirin dilemma”. Thromb Haemost 1985; 53 (03) 415-418
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 11 Bertele V, Falanga A, Tomasiak M, Dejana E, Cerletti C, de Gaetano G. Platelet thromboxane synthetase inhibitors with low doses of aspirin: possible resolution of the “aspirin dilemma”. Science 1983; 220 (4596) 517-519
    CrossrefPubMedGoogle Scholar
  • 12 The Dutch TIA Trial Study Group: A comparison of two doses of aspirin (30 mg vs. 283 mg a day) in patients after a transient ischemic attack or minor ischemic stroke. N Engl J Med 1991; 325 (18) 1261-1266
    CrossrefPubMed
  • 13 Hawiger J. Adhesive interactions of platelets and their blockade. Ann-N-YAcad-Sci 1991; 614: 270-278
    CrossrefPubMedGoogle Scholar
  • 14 Buchanan MR, Brister SJ. Individual variation in the effects of ASA on platelet function: implications for the use of ASA clinically. Can J Cardiol 1995; 11 (03) 221-227
    PubMedGoogle Scholar
  • 15 Buchanan MR, Rischke JA, Butt R, Turpie AG, Hirsh J, Rosenfeld J. The sex-related differences in aspirin pharmacokinetics in rabbits and man and its relationship to antiplatelet effects. Thromb Res 1983; 29 (02) 125-139
    CrossrefPubMedGoogle Scholar
  • 16 Fiore LD, Brophy MT, Lopez A, Janson P, Deykin D. The bleeding time response to aspirin. Identifying the hyperresponder. Am J Clin Pathol 1990; 94 (03) 292-296
    CrossrefPubMedGoogle Scholar
  • 17 Helgason CM, Bolin KM, Hoff JA, Winkler SR, Mangat A, Tortorice KL, Brace LD. Development of aspirin resistance in persons with previous ischemic stroke. Stroke 1994; 25 (12) 2331-2336
    CrossrefPubMedGoogle Scholar
  • 18 Beving H, Eksborg S, Malmgren RS, Nordlander R, Ryden L, Olsson P. Inter-individual variations of the effect of low dose aspirin regime on platelet cyclooxygenase activity. Thromb Res 1994; 74 (01) 39-51
    CrossrefPubMedGoogle Scholar
  • 19 Lee TK, Ng SK, Huang ZS, Chen YC. Dissociation of inhibitory effects of low-dose ASA on thromboxane production and platelet aggregation in ischemic stroke patients. J Formos Med Assoc 1992; 91 (09) 891-897
    PubMedGoogle Scholar
  • 20 Spranger M, Aspey BS, Harrison MJ. Sex difference in antithrombotic effect of aspirin. Stroke 1989; 20 (01) 34-37
    CrossrefPubMedGoogle Scholar
  • 21 Schreiner W, Mueller MR, Premauer W, Wolner E. Computerized Acquisition and Evaluation of Whole Blood Aggregometry Data. Comput Biol Med 1991; 21: 435-441
    CrossrefPubMedGoogle Scholar
  • 22 Mueller MR, Salat A, Pulaki S, Stangl P, Ergun E, Schreiner W, Losert U, Wolner E. Influence of hematocrit and platelet count on impedance and reactivity of whole blood for electrical aggregometry. JPM 1995; 34: 17-22
    PubMedGoogle Scholar
  • 23 Mueller MR, Schreiner W, Wohlfahrt A, Salat A, Wolner E. The influence of sample age on collagen-induced platelet aggregation in whole blood. Thromb Res 1990; 60: 477-487
    CrossrefPubMedGoogle Scholar
  • 24 Mueller MR, Salat A, Pulaki S, Schreiner W, Ergun E, Koppensteiner R, Losert U, Wolner E. Platelet function after total artificial heart replacement: clinical application and experiment. J Heart Lung Transplant 1993; 12 (03) 450-459
    PubMedGoogle Scholar
  • 25 Mantel N, Byar DP. Evaluation of Response-Time Data Involving Transient States: An Illustration Using Heart-Transplant Data. Journal of the American Statistical Association. 1974. 69. 81-86
    Google Scholar
  • 26 StatXact-Turbo. Statistical Software for Exact Nonparametric Inference. Cytel Software Corporation; Cambridge, MA, USA:
    Google Scholar
  • 27 Willard JE, Lange RA, Hillis LD. The use of aspirin in ischemic heart disease. N Engl J Med 1992; 327 (03) 175-181
    CrossrefPubMedGoogle Scholar
  • 28 Kuster LJ, Frolich JC. Platelet aggregation and thromboxane release induced by arachidonic acid, collagen, ADP and platelet-activating factor following low dose acetylsalicylic acid in man. Prostaglandins 1986; 32 (03) 415-423
    CrossrefPubMedGoogle Scholar
  • 29 Toivanen J, Ylikorkala O, Viinikka L. One milligramme of acetylsalicylic acid daily inhibits platelet thromboxane A2 production. Thromb Res 1984; 35 (06) 681-687
    CrossrefPubMedGoogle Scholar
  • 30 Mohri H, Ohkubo T. Single-dose effect of enteric-coated aspirin on platelet function and thromboxane generation in middle-aged men. Ann Pharmacother 1993; 27 (04) 405-410
    CrossrefPubMedGoogle Scholar
  • 31 Philp RB, Paul ML. Salicylate antagonism of acetylsalicylic acid inhibition of platelet aggregation in male and female subjects: influence of citrate concentration. Haemostasis 1986; 16 (05) 369-377
    PubMedGoogle Scholar
  • 32 Pappas JM, Westengard JC, Bull BS. Population variability in the effect of aspirin on platelet function. Implications for clinical trials and therapy Arch Pathol Lab Med 1994; 118 (08) 801-804
    PubMedGoogle Scholar
  • 33 Rao GH, White JG. Influence of various doses of aspirin (in vivo) on platelet arachidonic acid metabolism (ex vivo) and function. Prostaglandins Leukot Essent Fatty Acids 1994; 51 (01) 63-67
    CrossrefPubMedGoogle Scholar
  • 34 Violi F, Alessandri C, Pratico D, Guzzo A, Ghiselli A, Balsano F. Inhibition of cyclooxygenase-independent platelet aggregation by sodium salicylate. Thromb Res 1989; 54 (06) 583-593
    CrossrefPubMedGoogle Scholar
  • 35 FitzGerald GA, Oates JA, Hawiger J, Maas RL, Roberts 2d LJ, Lawson JA, Brash AR. Endogenous biosynthesis of prostacyclin and thromboxane and platelet function during chronic administration of aspirin in man. J Clin Invest 1983; 71 (03) 676-688
    CrossrefPubMedGoogle Scholar
  • 36 Trentalange MJ, Walts LF. A comparison of thromboelastogram and template bleeding time in the evaluation of platelet function after aspirin ingestion. J Clin Anesth 1991; 3 (05) 377-381
    CrossrefPubMedGoogle Scholar
  • 37 Kretschmer V, Schikor B, Sohngen D, Dietrich G. In vitro bleeding test – a simple method for the detection of aspirin effects on platelet function. Thromb Res 1989; 56 (05) 593-602
    CrossrefPubMedGoogle Scholar
  • 38 Orlikowski CE, Payne AJ, Moodley J, Rocke DA. Thrombelastography after aspirin ingestion in pregnant and non-pregnant subjects. Br J Anaesth 1992; 69 (02) 159-161
    CrossrefPubMedGoogle Scholar
  • 39 Stampfer MJ, Jakubowski JA, Deykin D, Schafer AI, Willett WC, Hennekens CH. Effect of altemate-day and enteric-coated aspirin on platelet aggregation, bleeding time, and thromboxane A2 levels in bleeding-time blood. Am J Med 1986; 81: 400-404
    CrossrefPubMedGoogle Scholar
  • 40 De Caterina R, Lanza M, Manca G, Strata GB, Maffei S, Salvatore L. Bleeding time and bleeding: an analysis of the relationship of the bleeding time test with parameters of surgical bleeding. Blood 1994; 84 (10) 3363-3370
    PubMedGoogle Scholar
  • 41 Bom GVR. Quantitative investigation into the aggregation of blood platelets. J Physiol 1962; 16: 67-68
    PubMedGoogle Scholar
  • 42 Taylor RR, Strophair J, Sturm M, Vandongen R, Beilin LJ. Time dependence of whole blood aggregation in response to platelet activating factor (PAF). Thromb Haemostasis 1988; 59 (02) 162-163
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 43 Hardeman MR, Vreeken J, Goedhart PT, Oosting PR. Transient aggregation resistance of human blood platelets in fresh plasma. I. Methodology. Thromb Res 1989; 54 (06) 719-731
    CrossrefPubMedGoogle Scholar
  • 44 Ingerman-Wojenski C, Smith B, Silver MJ. Evaluation of electrical aggregometry: comparison with optical aggregometry, secretion of ATP, and accumulation of radiolabeled platelets. J Lab Clin Med 1983; 101: 44-52
    PubMedGoogle Scholar
  • 45 Clemmons RM, Bliss EL, Dorsey-Lee MR, Seachord CL, Meyers KM. Platelet function, size and yield in whole blood and in platelet-rich plasma prepared using differing centrifugation force and time in domestic and food-producing animals. Thromb Haemost 1983; 50 (04) 838-843
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 46 Cardinal DC, Flower RJ. The electronic aggregometer: A novel device for assessing platelet behavior in blood. JPM 1980; 03: 135-158
    PubMedGoogle Scholar
  • 47 Boyd DG, Davis RB. Observations on human platelet aggregation in native whole blood: synergism and sensitivity to aggregating agents in vitro. Thromb Res 1988; 50 (03) 429-436
    CrossrefPubMedGoogle Scholar
  • 48 Russell-Smith N, Flower RJ, Cardinal DC. Measuring platelet and leucocyte aggregation/adhesion responses in very small volumes of whole blood. JPM 1981; 06: 315-333
    PubMedGoogle Scholar
  • 49 Mackie IJ, Jones R, Machin SJ. Platelet impedance aggregation in whole blood and its inhibition by antiplatelet drugs. J Clin Pathol 1984; 37: 874-878
    CrossrefPubMedGoogle Scholar
  • 50 Valles J, Santos MT, Marcus AJ, Safier LB, Broekman MJ, Islam N, Ullman HL, Aznar J. Downregulation of human platelet reactivity by neutrophils. Participation of lipoxygenase derivatives and adhesive proteins. J Clin Invest 1993; 92 (03) 1357-1365
    CrossrefPubMedGoogle Scholar
  • 51 Valles J, Santos MT, Aznar J, Marcus AJ, Martinez-Sales V, Portoles M, Broekman MJ, Safier LB. Erythrocytes metabolically enhance collageninduced platelet responsiveness via increased thromboxane production, adenosine diphosphate release, and recruitment. Blood 1991; 78 (01) 154-162
    CrossrefPubMedGoogle Scholar
  • 52 De La CruzJP, Pavia J, Bellido I, De La Cuesta SanchezF. Effect of trifiusal and acetylsalicylic acid on platelet aggregation in human whole blood: influence of red blood cells and leukocytes. Methods Find Exp Clin Pharmacol 1988; 10 (06) 363-367
    PubMedGoogle Scholar
  • 53 Sathiropas P, Marbet GA, Sahaphong S, Duckert F. Detection of small inhibitory effects of acetylsalicylic acid (ASA) by platelet impedance aggregometry in whole blood. Thromb Res 1988; 51 (01) 55-62
    CrossrefPubMedGoogle Scholar
  • 54 Zwierzina WD, Kunz F, Kogelnig R, Herold M. Sex-related differences in platelet aggregation in native whole blood. Thromb Res 1987; 48 (02) 161-171
    CrossrefPubMedGoogle Scholar
  • 55 Brezinski DA, Nesto RW, Serhan CN. Angioplasty triggers intracoronary leukotrienes and lipoxin A4. Impact of aspirin therapy. Circulation 1992; 86 (01) 56-63
    CrossrefPubMedGoogle Scholar
  • 56 Watala C, Gwozdzinski K. Effect of aspirin on conformation and dynamics of membrane proteins in platelets and erythrocytes. Biochem Pharmacol 1993; 45 (06) 1343-1349
    CrossrefPubMedGoogle Scholar
  • 57 Winocour PD, Watala C, Perry DW, Kinlough-Rathbone RL. Decreased platelet membrane fluidity due to glycation or acetylation of membrane proteins. Thromb Haemost 1992; 68 (05) 577-582
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 58 Burris SM, Smith SM, Rao GHR, White JG. Aspirin treatment reduces platelet resistance to deformation. Arteriosclerosis 1987; 07: 385-388
    CrossrefPubMedGoogle Scholar
  • 59 Smith SM, Burris SM, Rao GHR, White JG. Epinephrine-induced reversal of aspirin effects on platelet deformability. Thromb Res 1988; 51: 35-44
    CrossrefPubMedGoogle Scholar
  • 60 Schwartz L, Bourassa MG, Lesperance J, Aldridge HE, Kazim F, Salvatori VA, Henderson M, Bonan R, David PR. Aspirin and dipyridamole in the prevention of restenosis after percutaneous transluminal coronary angioplasty. N Engl J Med 1988; 318 (26) 1714-1719
    CrossrefPubMedGoogle Scholar
  • 61 Terres W, Hamm CW, Ruchelka A, Weilepp A, Kupper W. Residual platelet function under acetylsalicylic acid and the risk of restenosis after coronary angioplasty. J Cardiovasc Pharmacol 1992; 19 (02) 190-193
    CrossrefPubMedGoogle Scholar