Dual Antiplatelet Therapy After Coronary Artery Bypass Grafting in the Setting of Acute Coronary Syndrome

Bomb, Ritin; Oliphant, Carrie S.; Khouzam, Rami N.

doi:10.1016/j.amjcard.2015.03.050

Cited by 27 publications

(14 citation statements)

References 36 publications

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“…Although many studies have shown the efficacy of antiplatelet therapy during postoperative period, there is still no consensus on the dose of this treatment and whether it should be used as a single acetylsalicylic acid (ASA) drug or as combination therapy (ASA + Clopidogrel) [14] . In our study, high MPV values in patients with mortality and stenosis suggest that antiplatelet therapy should be widely used in these patients during postoperative period.…”

Section: Discussionmentioning

confidence: 99%

Predictive Value of Mean Platelet Volume in Saphenous Vein Graft Disease

Kaya

Koza

2018

Braz J Cardiovasc Surg

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ObjectiveTo determine whether mean platelet volume (MPV), platelet distribution width (PDW), and platelet count could be used as determinants of mortality following coronary artery bypass graft (CABG) surgery and patency of saphenous vein grafts (SVG).MethodsThe records of 128 patients who underwent emergency or elective coronary angiography after CABG surgery, and who died at an early stage were retrospectively reviewed. Patients were divided into three groups as early death, no SVG disease (SVGD), and SVGD group. MPV, PDW, and platelet count were evaluated at different times.ResultsMPV was significantly higher in the stenotic group than in the nonstenotic group (9.7±1.8 fl and 8.2±0.9 fl, P<0.05). The postoperative MPV ratio was found to be higher in the stenotic group when compared to the preoperative period (9.6±1.8 fl and 7.8±0.9 fl, P<0.05). MPV values were also found to be higher in patients who died during the early stage than in surviving patients (9.4±1.9 fl and 8.0±1.0 fl, P<0.05). There was no statistically significant difference regarding platelet count and PDW ratios between the early deaths group and surviving patients. An MPV value higher than 10.6 predicted SVGD with 85% sensitivity and 45% specificity; and an MPV higher than 7.9 predicted early death with 80% sensitivity and 68% specificity were observed.ConclusionMPV may be a useful indicator for the prediction of SVGD and mortality following CABG surgery.

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Section: Discussionmentioning

confidence: 99%

Predictive Value of Mean Platelet Volume in Saphenous Vein Graft Disease

Kaya

Koza

2018

Braz J Cardiovasc Surg

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“…Despite therapy, patients operated using a cardiopulmonary bypass showed increased platelet aggregation that rebounded to above preoperative levels [1,2]. Considering the mechanism of early graft failure, it seems logical that potent platelet inhibition may improve graft patency [3][4][5]. By contrast, it is known that an impaired response to antiplatelet therapy underlies the increased risk of post-operative occlusions and can even result in death after CABG surgery [6].…”

Section: Introductionmentioning

confidence: 99%

Platelet reactivity expressed as a novel platelet reactivity score is associated with higher inflammatory state after coronary artery bypass grafting

et al. 2019

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Introduction: Despite therapy, patients operated using a cardiopulmonary bypass demonstrate increased platelet aggregation, which rebounds to above preoperative levels. The aim of the study was to test the interaction between platelet reactivity/activation and selected inflammatory markers in the post-operative period. Material and methods: In total, 103 patients with non-ST elevation acute coronary syndrome (NSTE-ACS) who were not eligible for percutaneous coronary interventions (PCI), and required urgent revascularization, were included. Platelet reactivity was measured using the PFA-100 platelet analyser, multiple electrode aggregometry, and was expressed as a novel platelet reactivity score (PRS). Patients were divided using their PRS scores into high platelet relativity or low platelet reactivity subgroups (HPR or LPR). Platelet basal activation was measured using immunoassays for soluble P-selectin and soluble CD40L. We measured high-sensitivity C-reactive protein (CRP), and used immunoassays for tumour necrosis factor α (TNF-α) and interleukin 6 (IL-6) as inflammation markers. Results: Significant differences between HPR and LPR groups were found for CRP (mg/l): 81.5 vs. 44.6, p < 0.02; and TNF-α (pg/l): 3.51 vs. 2.37, p < 0.02. A significant association was found between CRP, TNF-α, IL-6 and platelet reactivity (platelet reactivity score). Cohen's k showed: CRP = 0.49, p < 0.0001, TNF-α = 0.37, p < 0.002. Perioperative myocardial infarction and rhythm disturbances occurred more frequently in the high platelet reactivity group: 7 (16.3%) vs. 2 (3.3%), p < 0.04, and 9 (20.9%) vs. 4 (6.7%), p < 0.04, respectively. Conclusions: Inflammatory parameters CRP and TNF-α are strongly associated with platelet reactivity (expressed as PRS) in cardiopulmonary bypass graft patients. Platelet hyperreactivity in the early post-operative period combined with a systemic inflammatory state correlates with a higher risk of post-operative rhythm disturbances and myocardial infarction.

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“…Other factors such as surgeon skill and institutional expertise may be the predominant contributing factors rather than the choice of surgical technique that impact the outcome. Current studies recommend that aggressive antiplatelet therapy using clopidogrel pre-and post-CABG surgery might improve long-term graft patency without forfeiting the ischemic benefit (56)(57)(58). However, the practice pattern will have little influential effect despite extensive evidence presented in this discussion.…”

Section: Appropriate Strategies and Algorithms For Opcabmentioning

confidence: 87%