Comparison of Intensity of Platelet Aggregation between Patients Receiving Low and High Aspirin Dosage in Post CABG Patients

Authors

  • Wanchai Wongkornrat Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700
  • Somchai Sriyoscharti Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700
  • Pansak Laksanabunsong Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700
  • Teeravit Phanchaipetch Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700
  • Thaworn Subtaweesin Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700
  • Punnarerk Thongchareon Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700
  • Pranya Sakiyalak Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700
  • Worawong Slisatkorn Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700
  • Nisarat Opartkiattikul Department of Clinical Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700

Keywords:

Aspirin dosage, platelet aggregation, post CABG patient

Abstract

Background: Aspirin used after coronary artery bypass graft surgery (CABG) improved patient survival and reduced graft
thrombosis. However, individual variations in the antiplatelet effect of aspirin have been reported among CABG patients.
Objective: To compare the intensity of platelet aggregation between patients receiving low and high aspirin dosage in post
CABG patients.
Methods: We prospectively studied the effect of aspirin dosage on platelet aggregation in 100 CABG patients. Oral aspirin
was discontinued prior to CABG and re-started within 12 hours after CABG. Blood samples were collected and transferred
to a laboratory prior to surgery then again on postoperative days two and eight for platelet aggregation test and platelet count
within three hours after venipuncture.
Results: One hundred patients (sixty five male and thirty five female patients) post coronary artery bypass graft (CABG) were
evaluated for eligibility to enter the trial. The percentage of platelet aggregation was compared between low dose (<100 mg/
day), and high dose (>100 mg/day) aspirin, at postoperative CABG days 2 and 8, which showed no significant difference for
the platelet aggregation (p = 0.161 post CABG day 2 and p = 0.098 post CABG day 8).
Conclusion: Low dosage aspirin should be used in post CABG patients because the intensity of platelet aggregation between
patients post CABG receiving low and high aspirin dosage were not different, while the prophylactic effect of the low aspirin
dosage in reducing the risk of cardiovascular events proved equally as effective as the high aspirin dosage.

References

1. Sanz G, Pajarón A, Alegría E, Coello I, Cardona M, Fournier JA, et al.
Prevention of early aortocoronary bypass occlusion by low-dose aspirin
and dipyridamole. Grupo Español para el Seguimiento del Injerto Coronario
(GESIC). Circulation. 1990 Sep;82(3):765-73.
2. Gavaghan TP, Gebski V, Baron DW. Immediate postoperative aspirin improves
vein graft patency early and late after coronary artery bypass graft
surgery. A placebo-controlled, randomized study. Circulation. 1991 May;
83(5):1526-33.
3. Chesebro JH, Fuster V, Elveback LR, Clements IP, Smith HC, Holmes
DR Jr, et al. Effect of dipyridamole and aspirin on late vein-graft patency
after coronary bypass operations. N Engl J Med. 1984 Jan 26;310(4):209-
14.
4. Lorenz RL, Schacky CV, Weber M, Meister W, Kotzur J, Reichardt B,
et al. Improved aortocoronary bypass patency by low-dose aspirin (100
mg daily). Effects on platelet aggregation and thromboxane formation.
Lancet. 1984 Jun 9;1(8389):1261-4.
5. Koch M, Gradaus F, Schoebel FC, Leschke M, Grabensee B. Relevance
of conventional cardiovascular risk factors for the prediction of coronary
artery disease in diabetic patients on renal replacement therapy. Nephrol
Dial Transplant. 1997 Jun;12(6):1187-91.
6. Mangano DT; Multicenter Study of Perioperative Ischemia Research
Group. Aspirin and mortality from coronary bypass surgery. N Engl J Med.
2002 Oct 24;347(17):1309-17.
7. Patrono C, Coller B, FitzGerald GA, et al. Platelet-active drugs, the relationships
among dose, effectiveness, and side effects: The seventh ACCP
conference on antithrombotic and thrombolytic therapy. Chest 2004;126
(3 Suppl):234S-264S.
8. Roque P. Bleeding as a complication of cardiopulmonary bypass: Management
of bleeding in cardiovascular surgery. 1st ed. Philadelphia: Hanley
& Belfus Inc; 2000. p. 1-7
9. Stephenson LW. History of Cardiac Surgery. In: Cohn LH, Edmunds
LH Jr, eds. Cardiac Surgery in the Adult. 2nd ed. New York: McGraw
Hill; c2003. p. 18.
10. Becker RC, Meade TW, Berger PB, Ezekowitz M, O’Connor CM, Vorchheimer
DA, et al. The primary and secondary prevention of coronary
artery disease: American College of Chest Physicians Evidence-Based
Clinical Practice Guidelines (8th Edition). Chest. 2008 Jun;133(6 Suppl):
776S-814S.
11. Altman R, Rouvier J, Gurfi nkel E, Scazziota A, Turpie AG. Comparison
of high dose with low dose aspirin in patients with mechanical heart valve
replacement treated with oral anticoagulant. Circulation. 1996 Nov 1;94
(9):2113-6.
12. Society of Thoracic Surgeons Blood Conservation Guideline Task Force,
Ferraris VA, Ferraris SP, Saha SP, Hessel EA 2nd, Haan CK, et al. Perioperative
blood transfusion and blood conservation in cardiac surgery: the
Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists
clinical practice guideline. Ann Thorac Surg. 2007 May;83(5 Suppl):S27-86.

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Published

03-04-2020

How to Cite

Wongkornrat, W. ., Sriyoscharti, S. ., Laksanabunsong, P. ., Phanchaipetch, T. ., Subtaweesin, T. ., Thongchareon, P. ., Sakiyalak, P. ., Slisatkorn, W. ., & Opartkiattikul, N. . (2020). Comparison of Intensity of Platelet Aggregation between Patients Receiving Low and High Aspirin Dosage in Post CABG Patients. Siriraj Medical Journal, 63(6), 187–190. Retrieved from https://he02.tci-thaijo.org/index.php/sirirajmedj/article/view/241005

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