Assessment of platelet function by whole blood impedance aggregometry in coronary artery bypass grafting patients on acetylsalicylic acid treatment may prompt a switch to dual antiplatelet therapy

Petričević, Mate; Biočina, Bojan; Konosić, Sanja; Kopjar, Tomislav; Kunac, Nino; Gašparović, Hrvoje

doi:10.1007/s00380-011-0216-3

Cited by 36 publications

(45 citation statements)

References 36 publications

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“…If longitudinal follow up is not feasible for some reason, distinction between "permanently" and "temporary" resistance could help in tailoring APT management. As we have previously shown [10], patients may express platelet reactivity turnaround in the early postoperative phase resulting in higher proportion of aspirin resistant patients. The resistance is probably a permanent one if detected both pre-and postoperatively [10].…”

Section: Implications For Everyday Clinical Practicementioning

confidence: 86%

“…As we have previously shown [10], patients may express platelet reactivity turnaround in the early postoperative phase resulting in higher proportion of aspirin resistant patients. The resistance is probably a permanent one if detected both pre-and postoperatively [10]. If platelets respond to aspirin adequately in preoperative phase, but acquire aspirin resistance in the early postoperative period, this resistance is more likely to be transient [10].…”

Section: Implications For Everyday Clinical Practicementioning

confidence: 86%

“…In addition to this, we have evaluated the perioperative dynamics of platelet reactivity and have found that patients have hyperactive platelets in early postoperative phase resulting in a significant increase in prevalence of aspirin resistance in the early postoperative phase [10] . Furthermore, we evaluated the clinical relevance of aspirin resistance [11] as well as the treatment modalities to overcome aspirin resistance [2,7,8].…”

Section: Postoperative Considerationsmentioning

confidence: 99%

“…Based upon our own clinical and research experience using multiple electrode aggregometry (MEA) (Multiplate® ; Roche Diagnostics, Mannheim, Germany) in this particular field [2][3][4][5][6][7][8][9][10][11][12][13], we sought to define pre-and post CAS therapeutic window for the most commonly administered APT such as aspirin and adenosine di-phosphate receptor blockers.…”

Section: Introductionmentioning

confidence: 99%

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Development of a concept for a personalized approach in the perioperative antiplatelet therapy administration/discontinuation management based on multiple electrode aggregometry in patients undergoing coronary artery surgery

Petričević

Miličić

White

et al. 2015

J Thromb Thrombolysis

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administration/discontinuation management. Despite emerging evidence on the widespread variability in platelet inhibitory response to APT, numerous PFT devices and heterogeneity in reporting study results hamper pooling of the evidence which in turn results with a lack of consensus in "on treatment" platelet reactivity associated with ischemic and bleeding events in perioperative phase. MethodsThe literature on multiple electrode aggregometry (Multiplate® ; Roche Diagnostics, Mannheim, Germany) in coronary artery disease patients was reviewed systematically. Based on the evidence evaluating the relationship between "drug specific" PFT and bleeding or adverse ischemic events, we sought to define therapeutic window for the most commonly administered antiplatelet drugs such as aspirin (ASPI test) and adenosine-diphosphate receptor blockers (ADP test). ResultsPreoperatively, APT administration was primarily focused to avoid bleeding complications.ASPI test value of 20 AUC and ADP test value of <73 AUC were set as cut-off values that delineate bleeding tendency. Postoperatively, "therapeutic window" was set to avoid both 3 bleeding and adverse ischemic events. Therapeutic ranges were as follows: 20AUC

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Section: Implications For Everyday Clinical Practicementioning

confidence: 86%

Section: Implications For Everyday Clinical Practicementioning

confidence: 86%

Section: Postoperative Considerationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Development of a concept for a personalized approach in the perioperative antiplatelet therapy administration/discontinuation management based on multiple electrode aggregometry in patients undergoing coronary artery surgery

Petričević

Miličić

White

et al. 2015

J Thromb Thrombolysis

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“…A meta-analysis of placebo-controlled aspirin trials, including more than 125 000 patients in a variety of clinical settings, found a 3% absolute reduction ischemic events (cardiovascular death, MI or stroke) associated with aspirin therapy (RR 1⁄4 22%) [30]. Most studies reported variable degrees of aspirin resistance, reaching as high as 90% in the early period after surgery but fading out by 6 months after surgery [37,38]. A randomised control trial (RCT) of 420 Chinese patients randomised to off pump coronary artery bypass grafting (OPCAB) vs. optimal medical therapy, reported high onaspirin RPR (residual platelet activity) after OPCAB (OR = 4.5; 95% CI, 1.8-11.1); 15.7% on day 4, 4.6% on day 10 and 0% at 6th month postsurgery.…”

Section: Aspirin Monotherapymentioning

confidence: 99%

http://oatext.com/Dual-antiplatelet-therapy-after-coronary-artery-bypass-grafting-Do-we-have-a-consensus.php

Jaaly¹,

Zakkar²,

Pufulete³

et al. 2015

J Integr Cardiol

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Coronary artery bypass grafting (CABG) remains the gold standard treatment in patients with complex multivessel coronary artery disease (CAD). Reversed long saphenous vein is the most commonly used conduit despite the known early thrombotic failure and low long-term patency rate. Post-operative antiplatelet therapy is an established treatment to improve graft patency and also a secondary treatment of the underlying native CAD.Aspirin has traditionally been the first line therapy; however, aspirin resistance especially in the early period after CABG, has been reported over the years and as a result, the use of dual antiplatelet therapy (DAPT) has become more common. However, there is limited evidence about the effect of DAPT and duration of use after CABG on graft patency, clinical outcomes (such as bleeding and myocardial infarction), and survival. The optimal dose of aspirin when given in DAPT is unclear and the duration of DAPT in association with quality of life is unknown.Furthermore, a better understanding of the pathology of vein graft disease and how available drugs influence it, could lead to the development of customised therapy for cohorts of patients undergoing CABG with potential benefits to early and long term outcomes. Here we review the available evidence on the routine use of DAPT after CABG. Coronary artery bypass grafting (CABG)Ischaemic heart disease (IHD) is the main leading cause of death in the world, with 7.4 million deaths in 2012 [1,2]. Coronary artery bypass grafting (CABG) is the gold standard intervention in patients with complex multivessel disease [3]. In the UK, there are about 25,000 CABG operations performed annually [4] and the majority of these operations is carried out on patients over 70 years of age [5]. Demand for CABG is likely to increase considerably in the future as a result of rapidly ageing populations [6] and increased expectations of patients and surgeons to expand their indications for surgery.During the early years of coronary surgery, saphenous vein grafts (SVGs) were the only conduits used [7]. Over the years different arterial conduits were introduced with variable degree of success [8][9][10]. Contemporary data on international use of grafts are available from the SYNTAX trial that included 1541 patients who underwent CABG at 85 sites in 18 countries between 2005 and 2007 [11]. The SYNTAX trial confirmed that the long saphenous vein (LSV) graft, is the most used conduit for multivessel revascularisation, despite its known low early and late patency rates.The underlying mechanism behind vein graft disease is multifactorial and can include conduit trauma/graft thrombosis (within 1 month, early failure), activation of intimal hyperplasia associated with harvest and implantation into the arterial high-pressure system (1 to 12 months, intermediate failure), superimposed atherosclerosis (beyond 12 months, late failure) [12][13][14][15]. A prospective cohort study of 1,388 patients carried out between 1969 to 1994, in which patency was assessed using coronary...

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Impact and Diagnosis of Antiplatelet Therapy Resistance in Patients Undergoing Cardiac Surgery

Gašparović

Petričević

Biočina

2013

Drug Development Research

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Coronary artery bypass grafting (CABG) is highly effective in the treatment of severe coronary artery disease. Antiplatelet therapy is a critical component of the medical management of patients following CABG. Patient idiosyncrasies in responsiveness to antiplatelet agents, however, lead to variable suppression of platelet aggregation. This problem is underscored by inconsistent findings from the different laboratory instruments used to document antiplatelet drug responsiveness and its uncertain clinical impact. The laboratory results reveal a spectrum of platelet inhibition effects. The cutoff values discriminating between "resistance" and "response" to antiplatelet therapy often rely solely on definition. It is therefore not surprising that regular testing for antiplatelet therapy response has neither been routinely instituted in a wider clinical arena nor is there unequivocal evidence to support it. The purpose of this review is to offer insight into the incidence and clinical impact of antiplatelet therapy resistance in patients undergoing surgical myocardial revascularization. Drug Dev Res 74 : 492-504, 2013.

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Assessment of platelet function by whole blood impedance aggregometry in coronary artery bypass grafting patients on acetylsalicylic acid treatment may prompt a switch to dual antiplatelet therapy

Cited by 36 publications

References 36 publications

Development of a concept for a personalized approach in the perioperative antiplatelet therapy administration/discontinuation management based on multiple electrode aggregometry in patients undergoing coronary artery surgery

Development of a concept for a personalized approach in the perioperative antiplatelet therapy administration/discontinuation management based on multiple electrode aggregometry in patients undergoing coronary artery surgery

http://oatext.com/Dual-antiplatelet-therapy-after-coronary-artery-bypass-grafting-Do-we-have-a-consensus.php

Impact and Diagnosis of Antiplatelet Therapy Resistance in Patients Undergoing Cardiac Surgery

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