Definition of aspirin resistance using whole blood impedance aggregometry in patients undergoing coronary artery surgery: methodological challenges and outcome improvement opportunities

Petričević, Mate; Biočina, Bojan; Konosić, Sanja; Burcar, Ivan; Ivančan, Višnja; Strapajevic, D; Svetina, Lucija; Habeković, Renata; Hižar, Željkica; Gašparović, Hrvoje

doi:10.1186/1749-8090-8-s1-p122

Cited by 8 publications

(13 citation statements)

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“…Current anti-platelet drugs block such receptors to reduce platelet hyper-activation and help reduce risk of thrombosis in vascular conditions. Though anti-platelet drugs such as aspirin and clopidogrel have been mainstay treatments in reducing thrombotic risks, there have been several reports of resistance and sensitivity (Goh, Churilov, Mitchell, Dowling, & Yan, 2013;Petricevic et al, 2013). Combination therapy using aspirin, clopidogrel and warfarin has also been associated with significant bleeding risk (Khurram et al, 2006).…”

Section: Introductionmentioning

confidence: 97%

Consumption of anthocyanin-rich Queen Garnet plum juice reduces platelet activation related thrombogenesis in healthy volunteers

Santhakumar

Kundur

Fanning³

et al. 2015

Journal of Functional Foods

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Available online A B S T R A C TThe anti-thrombotic properties of an anthocyanin-rich Queen Garnet plum juice (QGPJ) and anthocyanin-free prune juice (PJ) were studied in this randomised, double-blind, crossover trial. Twenty-one healthy subjects (M = 10, F = 11) consumed QGPJ, PJ or placebo, 200 mL/ day for 28-days followed by a 2-week wash-out period. Only QGPJ supplementation inhibited platelet aggregation induced by ADP (<5%, P = 0.02), collagen (<2.7%, P < 0.001) and arachidonic acid (<4%, P < 0.001); reduced platelet activation-dependent surface-marker P-selectin expression of activated de-granulated platelets (<17.2%, P = 0.04); prolonged activatedpartial thromboplastin clotting time (>2.1 s, P = 0.03); reduced plasma-fibrinogen (<7.5%, P = 0.02) and malondialdehyde levels, a plasma biomarker of oxidative stress (P = 0.016). PJ supplementation increased plasma hippuric acid content (P = 0.018). QGPJ or PJ supplementation did not affect blood cell counts, lipid profile, or inflammation markers. Our findings suggest that QGPJ but not PJ has the potential to significantly attenuate thrombosis by reducing platelet activation/hyper-coagulability and oxidative stress.

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Section: Introductionmentioning

confidence: 97%

Consumption of anthocyanin-rich Queen Garnet plum juice reduces platelet activation related thrombogenesis in healthy volunteers

Santhakumar

Kundur

Fanning³

et al. 2015

Journal of Functional Foods

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“…The aim would be to create a "safety window" framed between bleeding and thromboembolic events. According to our own experience in cardiac surgery patients, 7,8,45,50 two types of hemostatic point-of-care devices could be used: (1) rotational thromboelastometry and (2) platelet function testing. Detailed description of these devices has already been published.…”

Section: Thrombotic Events In Patients Undergoing Mechanical Circulatmentioning

confidence: 99%

Bleeding and Thrombotic Events in Patients Undergoing Mechanical Circulatory Support: A Review of Literature

Petričević

Miličić

Boban

et al. 2015

Thorac cardiovasc Surg

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Bleeding and thrombotic events are among the most common complications detected in patients with mechanical circulatory support (MCS). Herein, we reviewed the available evidence on the prevalence, etiology, and management of bleeding and thrombotic events in patients following MCS procedures, such as implantation of both intra- and paracorporeal devices that generate either pulsatile or nonpulsatile flow. Extracorporeal life support procedures providing support to the failing heart and lungs were also reviewed. Most bleeding and thromboembolic events occur despite appropriate hemostatic and anticoagulation management based on conventional coagulation laboratory parameters. Prevalence of bleeding events in this population ranges between 5 and 81%. Wide range in prevalence of bleeding reported in literature may be explained by different devices with different anticoagulation protocols being used, as well as different definitions of bleeding outcomes. Although bleeding events are more common than thromboembolic events, the consequences of thrombotic events are often detrimental. Management of bleeding events remains challenging and measures to prevent and treat bleeding events are often followed by thromboembolic events. Therefore, a personalized approach based on point-of-care hemostatic tests and adjusted to device type and patient comorbidities is therefore warranted. To provide advanced understanding of hemostatic disturbances during MCS, prospective trials focused on bleeding and thromboembolic events as primary endpoints should be conducted. Better understanding of the underlying pathophysiology and a shift towards a personalized approach based on functional point-of-care hemostatic properties assessment may provide more favorable clinical outcomes. This should, however, be coupled with further technological improvements providing better device surface hemocompatibility as interaction between blood and device surface affects the hemostatic equilibrium.

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“…Using MEA ASPI test, our working group defined resistance to aspirin in patients undergoing CAS [9]. In addition to this, we have evaluated the perioperative dynamics of platelet reactivity and have found that patients have hyperactive platelets in early postoperative phase resulting in a significant increase in prevalence of aspirin resistance in the early postoperative phase [10] .…”

Section: Postoperative Considerationsmentioning

confidence: 99%

“…Our working group has defined aspirin resistance using MEA [9] in patients undergoing CAS [9]. ASPI test value of ≥30 AUC indicated aspirin resistance.…”

Section: Postoperative Considerationsmentioning

confidence: 99%

“…Based upon our own clinical and research experience using multiple electrode aggregometry (MEA) (Multiplate® ; Roche Diagnostics, Mannheim, Germany) in this particular field [2][3][4][5][6][7][8][9][10][11][12][13], we sought to define pre-and post CAS therapeutic window for the most commonly administered APT such as aspirin and adenosine di-phosphate receptor blockers.…”

Section: Introductionmentioning

confidence: 99%

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Development of a concept for a personalized approach in the perioperative antiplatelet therapy administration/discontinuation management based on multiple electrode aggregometry in patients undergoing coronary artery surgery

Petričević

Miličić

White

et al. 2015

J Thromb Thrombolysis

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administration/discontinuation management. Despite emerging evidence on the widespread variability in platelet inhibitory response to APT, numerous PFT devices and heterogeneity in reporting study results hamper pooling of the evidence which in turn results with a lack of consensus in "on treatment" platelet reactivity associated with ischemic and bleeding events in perioperative phase. MethodsThe literature on multiple electrode aggregometry (Multiplate® ; Roche Diagnostics, Mannheim, Germany) in coronary artery disease patients was reviewed systematically. Based on the evidence evaluating the relationship between "drug specific" PFT and bleeding or adverse ischemic events, we sought to define therapeutic window for the most commonly administered antiplatelet drugs such as aspirin (ASPI test) and adenosine-diphosphate receptor blockers (ADP test). ResultsPreoperatively, APT administration was primarily focused to avoid bleeding complications.ASPI test value of 20 AUC and ADP test value of <73 AUC were set as cut-off values that delineate bleeding tendency. Postoperatively, "therapeutic window" was set to avoid both 3 bleeding and adverse ischemic events. Therapeutic ranges were as follows: 20AUC

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Definition of aspirin resistance using whole blood impedance aggregometry in patients undergoing coronary artery surgery: methodological challenges and outcome improvement opportunities

Cited by 8 publications

References 0 publications

Consumption of anthocyanin-rich Queen Garnet plum juice reduces platelet activation related thrombogenesis in healthy volunteers

Consumption of anthocyanin-rich Queen Garnet plum juice reduces platelet activation related thrombogenesis in healthy volunteers

Bleeding and Thrombotic Events in Patients Undergoing Mechanical Circulatory Support: A Review of Literature

Development of a concept for a personalized approach in the perioperative antiplatelet therapy administration/discontinuation management based on multiple electrode aggregometry in patients undergoing coronary artery surgery

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