Effects of preoperative aspirin on perioperative platelet activation and dysfunction in patients undergoing off-pump coronary artery bypass graft surgery: A prospective randomized study

Jiwon Lee, Chul-Woo Jung, Yunseok Jeon, Tae Kyong Kim, Youn Joung Cho, Chang-Hoon Koo, Yoon Hyeong Choi, Ki-Bong Kim, Ho Young Hwang, Hang-Rae Kim, Ji-Young Park, Jiwon Lee, Chul-Woo Jung, Yunseok Jeon, Tae Kyong Kim, Youn Joung Cho, Chang-Hoon Koo, Yoon Hyeong Choi, Ki-Bong Kim, Ho Young Hwang, Hang-Rae Kim, Ji-Young Park

Abstract

The benefit of aspirin use after coronary artery bypass graft surgery has been well proven. However, the effect of preoperative aspirin use in patients undergoing off-pump coronary artery bypass graft surgery (OPCAB) has not been evaluated sufficiently. To evaluate platelet function changes during OPCAB due to preoperative aspirin use, we conducted a randomized controlled trial using flow cytometry and the Multiplate® analyzer. Forty-eight patients scheduled for elective OPCAB were randomized to the aspirin continuation (100 mg/day until operative day) and discontinuation (4 days before the operative day) groups. Platelet function was measured using the platelet activation markers CD62P, CD63, and PAC-1 by flow cytometry, and platelet aggregation was measured using the Multiplate® analyzer, after the induction of anesthesia (baseline), at the end of the operation, and 24 and 48 h postoperatively. Findings of conventional coagulation assays, thromboelastography by ROTEM® assays, and postoperative bleeding-related clinical outcomes were compared between groups. No significant change in CD62P, CD63, or PAC-1 was observed at the end of the operation or 24 or 48 h postoperatively compared with baseline in either group. The area under the curve for arachidonic acid-stimulated platelet aggregation, measured by the Multiplate® analyzer, was significantly smaller in the aspirin continuation group (P < 0.01). However, chest tube drainage and intraoperative and postoperative transfusion requirements did not differ between groups. Our study showed that preoperative use of aspirin for OPCAB did not affect perioperative platelet activation, but it impaired platelet aggregation, which did not affect postoperative bleeding, by arachidonic acid.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. CONSORT flow diagram.
Fig 1. CONSORT flow diagram.
Fig 2. Increments of surface expression of…
Fig 2. Increments of surface expression of P-selectin (CD62P; A, B), glycoprotein 53 (CD63; C, D), and activated GP IIb/IIIa (PAC-1; E, F) on platelets from patients undergoing OPCAB.
Data are expressed as means with standard deviations (A, C, E), representative flow cytometry histogram (B, D, F).
Fig 3. Platelet aggregation induced by ADP…
Fig 3. Platelet aggregation induced by ADP and arachidonic acid, as determined with the Multiplate® analyzer, in patients undergoing OPCAB.
T1, immediately after induction; T2, at the end of the operation; T3, 24 h postoperatively; T4, 48 h postoperatively. Data were analyzed using mixed-effect models for repeated measures with Bonferroni adjustment. Data are expressed as means with standard deviations. A. ADP-induced platelet aggregation. *P < 0.05, significant time effect (vs. T1) in both groups. B. Arachidonic acid-induced platelet aggregation. **P < 0.05, significant interaction between group and time at all timepoints in both groups. † P < 0.05 between groups at all timepoints.

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