Effect of two doses of aspirin on thromboxane biosynthesis and platelet function in patients undergoing coronary surgery

Marta Brambilla; Alessandro Parolari; Marina Camera; Susanna Colli; Sonia Eligini; Chiara Centenaro; Achille Anselmo; Francesco Alamanni; Elena Tremoli

doi:10.1160/TH09-07-0470

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2010; 103(03): 516-524
DOI: 10.1160/TH09-07-0470

Theme Issue Article

Schattauer GmbH

Effect of two doses of aspirin on thromboxane biosynthesis and platelet function in patients undergoing coronary surgery

Marta Brambilla

¹Centro Cardiologico Monzino, IRCCS, Milano, Italy

,

Alessandro Parolari

¹Centro Cardiologico Monzino, IRCCS, Milano, Italy

⁴Department of Cardiovascular Sciences, Università degli Studi di Milano, Milano, Italy

,

Marina Camera

¹Centro Cardiologico Monzino, IRCCS, Milano, Italy

²Department of Pharmacological Sciences, Università degli Studi di Milano, Milano, Italy

,

Susanna Colli

²Department of Pharmacological Sciences, Università degli Studi di Milano, Milano, Italy

,

Sonia Eligini

²Department of Pharmacological Sciences, Università degli Studi di Milano, Milano, Italy

,

Chiara Centenaro

¹Centro Cardiologico Monzino, IRCCS, Milano, Italy

,

Achille Anselmo

¹Centro Cardiologico Monzino, IRCCS, Milano, Italy

³Department of Inflammation and Immunology, Istituto Clinico Humanitas, Rozzano, Milano, Italy

,

Francesco Alamanni

¹Centro Cardiologico Monzino, IRCCS, Milano, Italy

⁴Department of Cardiovascular Sciences, Università degli Studi di Milano, Milano, Italy

,

Elena Tremoli

¹Centro Cardiologico Monzino, IRCCS, Milano, Italy

²Department of Pharmacological Sciences, Università degli Studi di Milano, Milano, Italy

› Institutsangaben

Abstract

Summary

Early post-operative aspirin improves survival in patients undergoing coronary artery bypass graft (CABG). However, most patients do not benefit of aspirin after CABG, still remaining at risk of thrombotic events due to insufficient platelet inhibition, specifically via the thromboxane (TX) pathway. We evaluated the effect of two aspirin doses (100 or 325 mg daily, enteric coated formulations) on platelet function and TX biosynthesis in patients after CABG and assessed whether the incidence of residual platelet reactivity could be reduced by the higher dose. Fifty-six patients undergoing CABG were randomly assigned to 100 or 325 mg aspirin daily for five days in a prospective single-centre study. Treatment effect was assessed by measuring either platelet function (light-transmission aggregometry and point-of-care PFA-100^®) or TX biosynthesis in collagen-stimulated platelets, serum, urine, and in lipopolysaccharide (LPS)-cultured whole blood (WB). An insufficient TX inhibition was observed with 100 mg aspirin but not with the higher dose. The different effect of the two doses was, however, highlighted by either TX (platelet- or serum-derived) or by PFA-100^® but not by the other assays. In conclusion, early after CABG, the incidence of residual platelet activity was lower in patients who received 325 mg aspirin. Moreover, evidence was provided that different methods yield different results in the detection of aspirin resistance, rendering them not interchangeable.

Keywords

Aspirin - coronary surgery - platelet pharmacology - platelet aggregation - thromboxane

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