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ESRD markedly increases bleeding and device-related infections. The risk of both complications parallels the severity of CKD. Further research is needed to reduce adverse outcomes in this high-risk population.

Objectives To determine if an incomplete response to and/or inadequate antiplatelet effect of aspirin contribute to saphenous vein graft (SVG) occlusion after coronary artery bypass graft (CABG) surgery. Background Thrombosis is the predominant cause of early SVG occlusion. Aspirin, which inhibits cyclooxygenase-1 activity and thromboxane generation in platelets, reduces early SVG occlusion by half. Methods Aspirin-responsiveness and platelet reactivity were characterized 3 days and 6 months after CABG in 229 subjects on aspirin monotherapy by; platelet aggregation to arachidonic acid, ADP, collagen and epinephrine; PFA-100 closure time (CT) using collagen/epinephrine (CEPI) and collagen/ADP (CADP) agonist cartridges; VerifyNow Aspirin assay, and; urine levels of 11-dehydro-thromboxane B2 (UTXB2). SVG patency was determined 6 months after surgery by computed tomography coronary angiography. Results Inhibited arachidonic acid-induced platelet aggregation, indicative of aspirin-mediated cyclooxygenase-1 suppression, occurred in 95% and >99% of subjects 3 days and 6 months after surgery, respectively. Despite this, 73% and 31% of subjects at these times had elevated UTXB2. Among tested parameters, only UTXB2 and PFA-100 CADP CT measured 6 months after surgery correlated with outcome. By multivariate analysis, CADP CT ≤88 seconds (OR 2.85, P=0.006), target vessel diameter ≤1.5 mm (OR 2.38, P=0.01) and UTXB2 ≥450 pg/mg creatinine (OR 2.59, P=0.015) correlated with SVG occlusion. CADP CT and UTXB2 in combination further identified subjects at particularly high- and low-risk for SVG occlusion. Conclusions Aspirin-insensitive thromboxane generation measured by UTXB2 and shear-dependent platelet hyper-reactivity measured by PFA-100 CADP CT are novel independent risk factors for early SVG thrombosis after CABG surgery.

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