Aspirin Resistance in Single-Ventricle Physiology: Aspirin Prophylaxis Is Not Adequate to Inhibit Platelets in the Immediate Postoperative Period

Mir, Arshid; Frank, Summer; Journeycake, Janna M.; Wolovitis, Joshua; Guleserian, Kristine J.; Heistein, Lisa C.; Lemler, Matthew S.

doi:10.1016/j.athoracsur.2015.02.026

Cited by 35 publications

(51 citation statements)

References 29 publications

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“…In a series of 20 children with single-ventricle palliative shunt surgery who were monitored with thromboelastography to measure platelet function, 80% were aspirin resistant in the postoperative period. 32 Aspirin resistance is associated with increased risk of thrombosis in pediatric patients undergoing cardiac surgery. 26 AHA guidelines suggest that lowmolecular-weight heparin or warfarin treatment for at least one year (or until the lesion responsible for the risk has been corrected) is reasonable in children with a risk of cardiac embolism, 29 but in practice it appears that a limited proportion of patients with cardiac disease and AIS are managed in this way.…”

Section: Discussionmentioning

confidence: 99%

Arterial Ischemic Stroke Secondary to Cardiac Disease in Neonates and Children

Chung

Guilliams

Wilson

et al. 2019

Pediatric Neurology

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Objective: We describe the risk factors for peri-procedural and spontaneous arterial ischemic stroke (AIS) in children with cardiac disease. Methods: We identified children with cardiac causes of AIS enrolled in the International Pediatric Stroke Study registry from January 2003 to July 2014. Isolated patent foramen ovale was excluded. Periprocedural AIS (those occurring during or within 72 hours of cardiac surgery, cardiac catheterization, or mechanical circulatory support) and spontaneous AIS that occurred outside of these time periods were compared. Results: We identified 672 patients with congenital or acquired cardiac disease as the primary risk factor for AIS. Among these, 177 patients (26%) had peri-procedural AIS and 495 patients (74%) had spontaneous AIS. Among non-neonates, spontaneous AIS occurred at older ages (median 4.2 years, interquartile range 0.97 to 12.4) compared with peri-procedural AIS (median 2.4 years, interquartile range 0.35 to 6.1, P < 0.001). About a third of patients in both groups had a systemic illness at the time of AIS. Patients who had spontaneous AIS were more likely to have a preceding thrombotic event (16 % versus 9 %, P ¼ 0.02) and to have a moderate or severe neurological deficit at discharge (67% versus 33%, P ¼ 0.01) compared to those with peri-procedural AIS.

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Section: Discussionmentioning

confidence: 99%

Arterial Ischemic Stroke Secondary to Cardiac Disease in Neonates and Children

Chung

Guilliams

Wilson

et al. 2019

Pediatric Neurology

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“…The problem is compounded by a lack of a rational approach to anticoagulation management and monitoring. The study by Mir and colleagues [1] highlights important deficiencies in thrombosis prophylaxis with aspirin in single-ventricle neonates. Specifically, the study found that a significant proportion of patients undergoing therapy with aspirin at 20 mg per day after stage 1 palliation were unresponsive to aspirin.…”

Section: Invited Commentarymentioning

confidence: 97%

Invited Commentary

Emani

2015

The Annals of Thoracic Surgery

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“…Conditions to treat or prevent COX inhibitor Aspirin Fontan 26,27 Single-ventricle palliation 20 Tuberculous meningitis 28 Kawasaki disease 29,30 Kasabach- effective antiplatelet therapy monitoring tests for children, in addition to the lack of high-level evidence to support the routine use of monitoring. This review aims to synthesize the available data regarding monitoring of antiplatelet therapy in neonates and children, and to provide a thorough understanding of the application and relevance of antiplatelet therapy monitoring in clinical practice.…”

Section: Dosesmentioning

confidence: 99%

“…19 Mir et al used two monitoring tools, and patients resistant to aspirin according to TEG-PM values did not respond significantly to dose increases according to follow-up urinary TxB 2 levels. 20 Jakubowski et al evaluated real-time dose adjustment of prasugrel according to VerifyNow, and a dose increase was indicated in 23% of patients, where the majority responded to this change in regard to the laboratory tool used, but no clinical benefit was demonstrated. 21 No studies measured a clinical benefit after a dose increase in the antiplatelet based on antiplatelet-monitoring measurements.…”

Section: Antiplatelet Monitoring and Dosing Adjustmentsmentioning

confidence: 99%

Antiplatelet Therapy Monitoring in Neonates and Children

Huang

Soeharto

Damara

et al. 2018

Semin Thromb Hemost

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Antiplatelet agents are used for the prevention and treatment of thromboembolic disease in an increasingly complex population of pediatric patients. Despite their importance for clinical outcome, there is no consensus on the most effective monitoring strategies. This review describes the current state of knowledge focusing on antiplatelet therapy monitoring in children. The authors searched five databases (PubMed-NCBI, MEDLINE-OVID, SCOPUS-Elsevier, ScienceDirect, and Cochrane) from January 2000 to October 2017 using keywords selected a priori. Identified articles were sorted according to the antiplatelet agents administered, methods of antiplatelet monitoring, and outcome measures. Twenty studies were included, with 14 cohort studies, 3 randomized controlled trials, and 3 cross-sectional studies. Eleven different antiplatelet monitoring tools were used, with the most common being Light Transmission Aggregometry, Urinary Thromboxane, Thromboelastography with Platelet Mapping, and VerifyNow. In the majority of studies, antiplatelet therapy monitoring was used to describe adequacy or responsiveness to treatment based on laboratory cut-off values, which were not uniform and sourced from adult studies or extrapolated from test manuals. Several studies evaluated monitoring related to clinical outcome or adjusted therapy to reach predefined therapeutic targets. There was no single laboratory method found to be distinctly better for monitoring antiplatelet treatment. Associations between laboratory assays and clinical outcomes or assays and gold standard measurements were highly inconsistent. The current literature lacks consensus on clinical benefits and measurable effects of monitoring antiplatelet therapy in pediatric patients. This review highlights important areas for research required to determine the value of antiplatelet therapy monitoring in children.

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Aspirin Resistance in Single-Ventricle Physiology: Aspirin Prophylaxis Is Not Adequate to Inhibit Platelets in the Immediate Postoperative Period

Cited by 35 publications

References 29 publications

Arterial Ischemic Stroke Secondary to Cardiac Disease in Neonates and Children

Arterial Ischemic Stroke Secondary to Cardiac Disease in Neonates and Children

Invited Commentary

Antiplatelet Therapy Monitoring in Neonates and Children

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