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J Thorac Cardiovasc Surg 2001;121:982-984
© 2001 The American Association for Thoracic Surgery
Brief Communications |
From the Institut für Pharmakologie und Klinische Pharmakologieb and the Klinik für Thorax- und Kardiovaskuläre Chirurgie,a Heinrich Heine-Universität, Düsseldorf, Germany.
Received for publication May 12, 2000. Accepted for publication Sept 4, 2000. Address for reprints: Thomas Hohlfeld, MD, Institut für Pharmakologie und Klinische Pharmakologie, Heinrich Heine-Universität, Moorenstraße 5, 40225 Düsseldorf, Germany (E-mail: hohlfeld@uni-duesseldorf.de).
Aspirin is widely used to reduce graft thrombosis after coronary artery bypass grafting (CABG).
1 However, aspirin appears to not always be an effective inhibitor of platelet function because considerable individual variations in the antiplatelet effect of aspirin have been reported in patients assigned to CABG. 2
The antiplatelet effect of aspirin may be compromised by an enhanced platelet turnover, generating an increased fraction of platelets that is able to form thromboxane within the dosing intervals (usually 1 day). This may be of particular relevance for patients undergoing CABG after cardiopulmonary bypass, when postoperative platelet turnover is increased.
The present work examines whether the antiplatelet effect of aspirin, which is based on the inhibition of platelet thromboxane production, may be impaired by an increased platelet turnover. Determination of thromboxane in collagen-stimulated platelet-rich plasma after CABG showed a remarkable enhancement of the capacity for thromboxane formation, despite the fact that aspirin was administered at an antiplatelet dose (100 mg once daily) that largely suppressed thromboxane synthesis in healthy control subjects.
Methods
Subjects and drug administration
This study was conducted in agreement with the Declaration of Helsinki and was approved by the institutional ethics committee. Twenty-four consecutive patients were included who had stable coronary artery disease and underwent an elective CABG procedure (2- to 3-vessel disease). Informed written consent was obtained from each patient. Previous aspirin treatment was terminated at least 7 days before CABG. Tablets (Aspirin 100 protect; Bayer AG, Leverkusen, Germany) containing 100 mg of aspirin were administered every morning, starting on day 1 after the operation. Compliance was
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