Functional Evaluation of Platelet Aspirin Resistance after On-Pump Coronary Bypass Grafting Using Multiple Aggregation Tests

Kammerer, Inna; Bach, Jr; Saggau, W; Isgro, Frank

doi:10.1055/s-0030-1270711

Cited by 7 publications

(3 citation statements)

References 18 publications

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“…In addition, we observed that adenosine and cAMP had a positive correlation with the ADP induced IPA. Finally, in line with previous studies, cilostazol achieved a higher extent of IPA (ADP induced) compared with aspirin 17‐19 . These findings suggested that part of the antiplatelet effect after cilostazol administration might be mediated through the increased adenosine plasma concentration.…”

Section: Discussionsupporting

confidence: 90%

Cilostazol increases adenosine plasma concentration in patients with acute coronary syndrome

Xue

Wang

et al. 2020

J Clin Pharm Ther

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What is Known and Objective Cilostazol is a specific and strong inhibitor of phosphodiesterase (PDE) type III which can suppress the platelet aggregation by increasing cyclic adenosine monophosphate (cAMP) levels. The clinical benefit of cilostazol in ACS patients suggested that the drug may have non–platelet‐directed properties. Some in vitro and animal studies also indicated that the ‘pleiotropic’ properties of cilostazol might be related to the interaction with adenosine metabolism. Adenosine is an important regulatory metabolite and an inhibitor of platelet activation. However, no human study has been conducted to determine whether cilostazol could increase the adenosine plasma concentration in vivo. As a result, this study aimed to investigate the impact of cilostazol on adenosine plasma concentration (APC) in acute coronary syndrome (ACS) patients. Methods We prospectively analysed 149 ACS patients undergoing percutaneous coronary intervention (PCI) with drug‐eluting stents. The included patients were divided into two groups according to the presence (cilostazol group, n = 64) or absence (aspirin group, n = 85) of aspirin intolerance. The inhibition of platelet aggregation (IPA), APC and cAMP concentration was measured. Patient characteristics, medications and 30‐day clinical outcomes were examined. Results Patients receiving cilostazol had a significantly higher adenosine and cAMP plasma concentration than patients receiving aspirin (3.00 ± 0.67 vs 2.56 ± 0.74 mol/L, P < .001; 28.10 ± 14.74 vs 20.48 ± 11.35 pmol/mL, P = .0014). Cilostazol was associated with a higher inhibition rate of ADP induced platelet aggregation than aspirin (63.35 ± 26.71 vs 52.2 ± 28.35, P = .036). The plasma levels of adenosine and cAMP showed a positive correlation with ADP induced platelet aggregation. What is New and Conclusion Cilostazol increases adenosine concentration compared with aspirin. Its potent antiplatelet effect in ACS patients may be partly mediated by adenosine.

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Section: Discussionsupporting

confidence: 90%

Cilostazol increases adenosine plasma concentration in patients with acute coronary syndrome

Xue

Wang

et al. 2020

J Clin Pharm Ther

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“…These phasic changes in platelet activity make any predictive modelling in CABG quite challenging. Moreover, the diagnostic utility of defining platelet function by various tests is also problematic, especially with regard to assessing the effects of antiplatelet agents in heart surgery patients [29]. Some biomarkers, such as urine thromboxane and shear-dependent collagen-induced platelet reactivity post-CABG, were found to be useful predictors for thrombotic events [30], although the mortality data were not explored.…”

Section: Discussionmentioning

confidence: 99%

Low platelet activity predicts 30 days mortality in patients undergoing heart surgery

Kuliczkowski

Śliwka

Kaczmarski

et al. 2016

Blood Coagulation &Amp; Fibrinolysis

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Despite advanced techniques and improved clinical outcomes, patient survival following coronary artery bypass grafting (CABG) is still a major concern. Therefore, predicting future CABG mortality represents an unmet medical need and should be carefully explored. The objective of this study is to assess whether pre-CABG platelet activity corresponds with 30 days mortality post-CABG. Retrospective analyses of platelet biomarkers and death at 30 days in 478 heart surgery patients withdrawn from aspirin or/and clopidogrel. Platelet activity was assessed prior to CABG for aspirin (ASPI-test) with arachidonic acid and clopidogrel (ADP-test) utilizing Multiplate impedance aggregometer. Most patients (n = 198) underwent conventional CABG, off-pump (n = 162), minimally invasive (n = 30), artificial valve implantation (n = 48) or valves in combination with CABG (n = 40). There were 22 deaths at 30 days, including 10 in-hospital fatalities. With the cut-off value set below 407 area under curve (AUC) for the ASPI-test, the 30-day mortality was 5.90% for the lower cohort and 2.66% for patients with significantly higher platelet reactivity (P = 0.038). For the ADP-test with a cut-off at 400AUC, the 30-day mortality was 9.68% for the lower cohort and 3.66% for patients with higher platelet reactivity, representing a borderline significant difference (P = 0.046). Aside from the platelet indices, patients who received red blood cell (RBC) concentrate had a highly significant (P < 0.0001) risk of death at 30 days. Both aspirin and clopidogrel tests were useful in predicting 30 days mortality following heart surgery, suggesting the danger of diminished platelet activity prior to CABG in such high-risk patients. These preliminary evidence supports early discontinuation of antiplatelet therapy for elective CABG and requires adequately powered randomized trials to test the hypothesis and potentially improve survival.

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“…One of the studies on on-pump CABG patients agrees with previous findings suggesting that different platelet function assays that are suitable for detecting ASA resistance can not be used interchangeably. Simple linear regression analysis revealed significant association among CEPI-CT, AA TPA and AA IPA and collagen IPA Table 2 [14]. In the majority of cases AA IPA (impedance platelet aggregation induced by arachidonic acid) [16,17] and ADP-induced platelet aggregation [4] The clean comparison between both different procedures of CABG: on-and off-pump surgery is unperformed, the role of using extracorporeal circulation as potential destroyer of cell components for ASA Response uncertain.…”

Section: Asa Response Testsmentioning

confidence: 99%

Aspirin Therapy Resistance in Coronary Artery Bypass Grafting

Kammerer¹

2013

Artery Bypass

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Functional Evaluation of Platelet Aspirin Resistance after On-Pump Coronary Bypass Grafting Using Multiple Aggregation Tests

Cited by 7 publications

References 18 publications

Cilostazol increases adenosine plasma concentration in patients with acute coronary syndrome

Cilostazol increases adenosine plasma concentration in patients with acute coronary syndrome

Low platelet activity predicts 30 days mortality in patients undergoing heart surgery

Aspirin Therapy Resistance in Coronary Artery Bypass Grafting

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