Platelet activity and aspirin efficacy after off-pump compared with on-pump coronary artery bypass surgery: Results from the prospective randomized trial PRAGUE 11–Coronary Artery Bypass and REactivity of Thrombocytes (CABARET)

Bednář, František; Osmančík, Pavel; Vanek, Tomas; Móciková, Heidi; Jares, Martin; Straka, Zbyněk; Widimský, Petr

doi:10.1016/j.jtcvs.2008.03.052

Cited by 42 publications

(14 citation statements)

References 30 publications

(35 reference statements)

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“…Using flow cytometry, Bednar et al [16] detected a 53% increment of CD62P expression at 48 h postoperative in patients who underwent OPCAB after preoperative aspirin discontinuation, compared with those who underwent on-pump CABG after preoperative aspirin discontinuation. This findings suggests that platelet activation during the early postoperative period could be more serious during OPCAB than during on-pump CABG.…”

Section: Discussionmentioning

confidence: 99%

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Effects of preoperative aspirin on perioperative platelet activation and dysfunction in patients undergoing off-pump coronary artery bypass graft surgery: A prospective randomized study

et al. 2017

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The benefit of aspirin use after coronary artery bypass graft surgery has been well proven. However, the effect of preoperative aspirin use in patients undergoing off-pump coronary artery bypass graft surgery (OPCAB) has not been evaluated sufficiently. To evaluate platelet function changes during OPCAB due to preoperative aspirin use, we conducted a randomized controlled trial using flow cytometry and the Multiplate® analyzer. Forty-eight patients scheduled for elective OPCAB were randomized to the aspirin continuation (100 mg/day until operative day) and discontinuation (4 days before the operative day) groups. Platelet function was measured using the platelet activation markers CD62P, CD63, and PAC-1 by flow cytometry, and platelet aggregation was measured using the Multiplate® analyzer, after the induction of anesthesia (baseline), at the end of the operation, and 24 and 48 h postoperatively. Findings of conventional coagulation assays, thromboelastography by ROTEM® assays, and postoperative bleeding—related clinical outcomes were compared between groups. No significant change in CD62P, CD63, or PAC-1 was observed at the end of the operation or 24 or 48 h postoperatively compared with baseline in either group. The area under the curve for arachidonic acid—stimulated platelet aggregation, measured by the Multiplate® analyzer, was significantly smaller in the aspirin continuation group (P < 0.01). However, chest tube drainage and intraoperative and postoperative transfusion requirements did not differ between groups. Our study showed that preoperative use of aspirin for OPCAB did not affect perioperative platelet activation, but it impaired platelet aggregation, which did not affect postoperative bleeding, by arachidonic acid.

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Section: Discussionmentioning

confidence: 99%

“…Bednar et al presented 53% increment of CD62P expression at postoperative 48 hours in patients who stopped administration of preoperative aspirin in OPCAB [16]. We used these data to find out sample size for our study.…”

Section: Methodsmentioning

confidence: 99%

Effects of preoperative aspirin on perioperative platelet activation and dysfunction in patients undergoing off-pump coronary artery bypass graft surgery: A prospective randomized study

et al. 2017

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“…Several reports have documented the existence of a relative hypercoagulable state after off-pump surgery, associated with higher levels of postoperative platelet activity and a decrease in platelet sensitivity to aspirin after OPCAB. [52][53][54][55][56][57][58][59][60] Moreover, in some early studies of graft patency after OPCAB, vein graft occlusion was noticeably higher both early and late after OPCAB compared with conventional CABG. 53,61 Questions were therefore raised about whether antiplatelet therapy with aspirin alone would be sufficient for patients after OPCAB, and as early as 2003, leading off-pump centers instituted policy changes to treat all OPCAB patients with both clopidogrel and aspirin after surgery for a duration of 3 months.…”

Section: Off-pump Cabgmentioning

confidence: 99%

Secondary Prevention After Coronary Artery Bypass Graft Surgery

Kulik¹,

Ruel²,

Jneid³

et al. 2015

Circulation

333

185

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“…19,20 Furthermore, clopidogrel may work to prevent atherothrombotic events more effectively in off-pump CABG compared with on-pump CABG because of differences in platelet function early after surgery. 21,22 The CASCADE randomized trial showed that there was no difference in SVG patency or the volume of SVG intimal hyperplasia between aspirin-clopidogrel and aspirin-placebo groups. 6 However, most operations were performed on-pump in the CASCADE trial (96%), and, as a corollary, it is conceivable that the effects of clopidogrel on native CAD progression could be more pronounced with off-pump CABG than what the present study showed.…”

Section: September 9 2014mentioning

confidence: 99%

Impact of Clopidogrel Plus Aspirin Versus Aspirin Alone on the Progression of Native Coronary Artery Disease After Bypass Surgery

et al. 2014

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Background-The effects of dual antiplatelet therapy with aspirin and clopidogrel on the progression of native coronary artery disease after coronary artery bypass grafting are unknown. Methods and Results-In the Clopidogrel After Surgery for Coronary Artery DiseasE (CASCADE) trial, a total of 113 patients were randomized to receive aspirin plus clopidogrel or aspirin plus placebo for 1 year after coronary artery bypass grafting. In this secondary analysis, the 92 patients who underwent preoperative and 1-year postoperative angiograms at 2 centers had each of their coronary stenoses graded serially by using 6 thresholds (grade 0 . We compared the incidence and degree of evolving coronary artery disease between the 2 treatment groups. A total of 543 preoperative stenoses and occlusions were quantified and followed. At 1-year postoperatively, there were 103 evolving (94 worsened, 9 improved) and 22 new lesions. The right coronary artery territory and sites proximal to a graft were more commonly associated with worsening coronary artery disease (P≤0.02). There were no differences in clinical events between treatment groups, and the proportion of patients with evolving or new lesions was also similar (70% versus 74%, aspirin-clopidogrel versus aspirin-placebo, respectively; P=0.8). However, in evolving or new lesions, the mean grade change (1.1±1.0 versus 1.6±1.1, respectively; P=0.01) and the proportion of new occlusions (7% versus 22%; P=0.02) were lower in the aspirin-clopidogrel group. Conclusions-The addition of clopidogrel to aspirin correlates with less worsening of native coronary artery disease 1 year after coronary artery bypass grafting. These findings may help guide post-coronary artery bypass grafting antiplatelet therapy. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00228423.[(Circulation. 2014;130[suppl 1]:S12-S18.)

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Platelet activity and aspirin efficacy after off-pump compared with on-pump coronary artery bypass surgery: Results from the prospective randomized trial PRAGUE 11–Coronary Artery Bypass and REactivity of Thrombocytes (CABARET)

Abstract: The platelet activity is higher in the early postoperative period in off-pump compared with on-pump coronary artery bypass grafting. The present aspirin strategy seems to be insufficient in the early postoperative period, irrespective of the surgical technique used.

Cited by 42 publications

References 30 publications

Effects of preoperative aspirin on perioperative platelet activation and dysfunction in patients undergoing off-pump coronary artery bypass graft surgery: A prospective randomized study

Effects of preoperative aspirin on perioperative platelet activation and dysfunction in patients undergoing off-pump coronary artery bypass graft surgery: A prospective randomized study

Secondary Prevention After Coronary Artery Bypass Graft Surgery

Impact of Clopidogrel Plus Aspirin Versus Aspirin Alone on the Progression of Native Coronary Artery Disease After Bypass Surgery

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