Pleiotropic Effects of Acetylsalicylic Acid after Coronary Artery Bypass Grafting—Beyond Platelet Inhibition

Abstract

Acetylsalicylic acid (ASA) is one of the most frequently used medications worldwide. Yet, the main indications for ASA are the atherosclerosis-based cardiovascular diseases, including coronary artery disease (CAD). Despite the increasing number of percutaneous procedures to treat CAD, coronary artery bypass grafting (CABG) remains the treatment of choice in patients with multivessel CAD and intermediate or high anatomical lesion complexity. Taking into account that CABG is a potent activator of inflammation, ASA is an important part in the postoperative therapy, not only due to ASA antiplatelet action, but also as an anti-inflammatory agent. Additional benefits of ASA after CABG include anticancerogenic, hypotensive, antiproliferative, anti-osteoporotic, and neuroprotective effects, which are especially important in patients after CABG, prone to hypertension, graft occlusion, atherosclerosis progression, and cognitive impairment. Here, we discuss the pleiotropic effects of ASA after CABG and provide insights into the mechanisms underlying the benefits of treatment with ASA, beyond platelet inhibition. Since some of ASA pleiotropic effects seem to increase the risk of bleeding, it could be considered a starting point to investigate whether the increase of the intensity of the treatment with ASA after CABG is beneficial for the CABG group of patients.

Gene Expression Profiling of Markers of Inflammation, Angiogenesis, Coagulation and Fibrinolysis in Patients with Coronary Artery Disease with Very High Lipoprotein(a) Levels Treated with PCSK9 Inhibitors

“…However, we must be aware that in addition to statins, all of our patients have been treated for more than six months also with ACE inhibitors/sartans, β blockers, and acetylsalicylic acid. The effect on the parameters of inflammation is well-recognized for statins [ 16 , 17 ], ACE inhibitors/sartans [ 29 ], β blockers [ 30 ], and acetylsalicylic acid [ 31 ], while all of them except β blockers also affect coagulation and fibrinolysis [ 16 , 17 , 29 , 31 ]. The inflammatory cytokine IL-1β stimulates the endothelial cells and leukocytes to produce intracellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) [ 6 ].…”

D,L-Lysine-Acetylsalicylate + Glycine (LASAG) Reduces SARS-CoV-2 Replication and Shows an Additive Effect with Remdesivir

“…It is used for many indications, mainly due to its impact against inflammation and pain of a general nature. In addition to these analgesic and anti-inflammatory properties, ASA has anti-platelet, anti-thrombotic and neuroprotective effects [46]. However, adverse effects of ASA (e.g., bleeding, Reye's Syndrome in childcare) have to be taken into account, especially when high doses are administered [47,48].…”

Forging Ahead in Cardiovascular Disease Management

“…As we look ahead, more research on LMCA treatments will emerge, but finding the absolute best approach will remain an ongoing journey. In the next article, the authors [2] explore the various effects of acetylsalicylic acid (ASA) following CABG and offer a deeper understanding of how ASA helps beyond just inhibiting platelets. While some of ASA's effects appear to heighten bleeding risks, this raises questions about whether intensifying ASA treatment post-CABG is advantageous for these patients.…”