The Prevalence and Clinical Relevance of ASA Nonresponse After Cardiac Surgery: A Prospective Bicentric Study

Wand, Saskia; Adam, Elisabeth Hannah; Wetz, Anna Julienne; Meybohm, Patrick; Kunze-Szikszay, Nils; Zacharowski, Kai; Popov, Aron F.; Moritz, Anton; Moldenhauer, Lisa; Kaiser, Julia; Bauer, Martin; Weber, Christian Friedrich

doi:10.1177/1076029617693939

Cited by 8 publications

(17 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In contrast to Wand et al 14 we did not find a significant positive correlation between the surgical procedure time and nonresponder rate (p = 0.65). While the highest number of nonresponders was found in the EVAR group with the longest procedure time, the differences between the groups were not significant.…”

Section: Discussioncontrasting

confidence: 99%

“…The postoperative analgesia regimen in our trial mainly included NSAIDs and the pyrazolinone metamizole, which may have a supplement effect to the ASA nonresponder rate because of potential medical interference as they both practice their effect via the cyclooxygenase. 14 Last but not least, the omnipresent problem of noncompliance is the most usual cause for ASA nonresponse. 24,25 Our study has several limitations.…”

Section: Discussionmentioning

confidence: 99%

“…Wand et al 14 investigated 400 patients who underwent coronary artery bypass grafting (CABG) surgery. In their study 51.3% of patients on the third postoperative day and 71.3% of patients on the fifth postoperative day (p = 0.0049) were ASA nonresponders according to their analysis using Multiplate Analyzer using a cut-off which was also located at 400 AU × min.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

The Pre- and Postoperative Prevalence and Risk Factors of ASA Nonresponse in Vascular Surgery

Kazimi

Weber

Keese

et al. 2021

Clin Appl Thromb Hemost

Self Cite

View full text Add to dashboard Cite

Background An antiplatelet therapy with acetylsalicylic acid (ASA) is prescribed in the prevention of cardiovascular events, but around 24% of ASA takers are resistant to the treatment. Aim In this prospective, observational cohort study, we aimed to identify the prevalence and risk factors of ASA nonresponse in patients who underwent vascular surgery. Methods The study was conducted in the University hospital in Frankfurt am Main. In total, 70 patients were pre-treated with 100 mg of ASA per day and underwent either elective carotid thromboendarterectomy, femoral thromboendarterectomy or endovascular aneurysm repair of the abdominal aorta. The platelet function was measured on the first preoperative and the second or fourth postoperative day with the multiple electrode aggregometry by in-vitro stimulation with arachidonic acid (ASPItest) and thrombin receptor activating peptide 6 (TRAPtest). The primary end point was the in-vitro induced platelet aggregation in the ASPItest. If the ASPItest amounted ≥400 AU × min, the patients were categorized as ASA nonresponders. Results The total prevalence of ASA nonresponse in our study was 20% preoperatively and 35.7% postoperatively (p = 0.005). As significant predictors for ASA nonresponse, we demonstrated the area under the aggregation curve in the TRAPtest preoperatively (p = 0.04) and postoperatively (p = 0.02), and the two comorbidities arterial hypertension ( P < .001; rho 0.44) and diabetes mellitus (p = 0.04; rho 0.39), which are already well known to be associated with ASA nonresponse. Conclusion In conclusion, data of the study indicate a high incidence of perioperative, laboratory ASA nonresponse in patients undergoing vascular surgery.

show abstract

Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Pre- and Postoperative Prevalence and Risk Factors of ASA Nonresponse in Vascular Surgery

Kazimi

Weber

Keese

et al. 2021

Clin Appl Thromb Hemost

Self Cite

View full text Add to dashboard Cite

show abstract

“…It measures platelet aggregation by continuously monitoring electrical impedance changes due to activation of platelets and adhesion to the metal sensor electrodes in 3-5 separate channels in multiple electrode aggregometry (MEA). [14][15][16][17][18][19][20][21] Whole blood sample is used in each channel with the addition of arachidonic acid to assess the effect of aspirin (ASPItest ), ADP for platelet P2Y12 inhibitor effect (ADPtest ) or thrombin receptor agonist peptide to measure glycoprotein IIb/IIIa inhibitor effect (TRAPtest ). 14,[19][20][21] Collagen can also be used as a substitute for arachidonic acid to assess the effect of aspirin.…”

Section: Impedance Platelet Aggregometrymentioning

confidence: 99%

Antiplatelet Resistance in Coronary Artery Bypass Grafting: A Systematic Review

Thet

Khosravi

Egbulonu

et al. 2022

Preprint

View full text Add to dashboard Cite

Introduction: Aspirin and clopidogrel are the most commonly used antiplatelet agents, either alone or as dual therapy, in patients undergoing CABG surgery to reduce organ ischaemia and mortality. The systematic review aims to explore the resistance to the antiplatelet agents, how to assess it, and the effect of resistance on the outcomes in CABG surgery. Materials & methods: A systematic search is carried out on MEDLINE via Ovid, PubMed, Embase, the Cochrane Library Database and Google Scholar until November 2021 to look for studies evaluating the antiplatelet resistance in patients undergoing both on-pump and off-pump CABG surgery. Only high-quality studies were included after the risk of bias assessment. Results: A total of 17 studies, of which 3 randomised controlled trials and 14 observational studies were included after inclusion criteria is applied. The incidence of aspirin resistance ranges from 11-51.5%, whereas, clopidogrel resistance is 22%. A wide variety of different assessment methods for antiplatelets are reported. Antiplatelet resistance is a predictor of vein graft occlusion, with up to 13 fold increase in occlusion rate. There is no overall effect of aspirin resistance on mortality, stroke or myocardial infarction, however, clopidogrel resistance leads to higher mortality, MI and target vessel revascularisations. The effect of cardiopulmonary bypass on antiplatelet resistance is not clear. Conclusion: There is no uniform definition of antiplatelet resistance. Assessment methods differ greatly and their results are not interchangeable. Antiplatelet resistance is associated with a higher rate of graft occlusion in CABG patients. Aspirin resistance does not influence overall adverse outcomes, however, clopidogrel resistance leads to worse outcomes.

show abstract

“…A study on 60 patients who went to elective OPCABG and were divided into two groups to receive mono-antiplatelet treatment (MAPT) with ASA or DAPT with ASA and clopidogrel has shown that clopidogrel in addition to ASA reduces the incidence of OPCABGrelated aspirin resistance, DAPT can be safely applied early after surgery, and there were no significant differences between two groups in postoperative bleeding [49]. A recent prospective, observational, bicentric cohort study indicated a high incidence of perioperative ASA nonresponse in patients following CABG, and no effect on the incidence of cardiovascular events was recorded in the 1-year follow-up [50]. Similar was concluded in a small low-risk cohort patients in which reduced ASA responsiveness as assessed with impedance aggregometry was not associated with increased incidence of major adverse cardiac and thromboembolic events and mortality after CABG surgery [51].…”

Section: Resistance To Antiplatelet Therapy and Its Clinical Significmentioning

confidence: 99%

Antiplatelet Therapy after Coronary Artery Bypass Graft Surgery, Inconsistency of Clinical Practice and Clinical Significance of Proven Resistance to Antiplatelet Agents

Merkaš¹,

Lakušić²,

Fučkar³

et al. 2020

The Current Perspectives on Coronary Artery Bypass Grafting

View full text Add to dashboard Cite

Antiplatelet therapy is a very important part of medical therapy for patients after acute coronary syndrome (ACS) as well as in a stable coronary artery disease (CAD). The use of antiplatelet therapy after coronary artery bypass graft surgery (CABG) still is a controversial theme in daily clinical practice. While guidelines referring to dual antiplatelet therapy (DAPT) after ACS with proceeding percutaneous coronary intervention (PCI) are uniform, there are doubts regarding DAPT after CABG, especially in setting of chronic coronary syndrome (CCS). Recommendations are mostly based on expert opinion and not on multiple randomized controlled trials (RCT) or meta-analyses. Resistance to aspirin (acetylsalicylic acid, ASA) or other antiplatelet drugs is known after CABG, and further RCTs are needed to assess the effect on clinical outcome as well as the role of DAPT after CABG.

show abstract

The Prevalence and Clinical Relevance of ASA Nonresponse After Cardiac Surgery: A Prospective Bicentric Study

Cited by 8 publications

References 35 publications

The Pre- and Postoperative Prevalence and Risk Factors of ASA Nonresponse in Vascular Surgery

The Pre- and Postoperative Prevalence and Risk Factors of ASA Nonresponse in Vascular Surgery

Antiplatelet Resistance in Coronary Artery Bypass Grafting: A Systematic Review

Antiplatelet Therapy after Coronary Artery Bypass Graft Surgery, Inconsistency of Clinical Practice and Clinical Significance of Proven Resistance to Antiplatelet Agents

Contact Info

Product

Resources

About