Frequency of development of aspirin resistance in the early postoperative period and inadequate inhibition of thromboxane A2 production after coronary artery bypass surgery

Hayrettin Özkan; İlker Kiriş; Şenol Gülmen; Hüseyin Okutan; Filiz Alkaya Solmaz; Kenan Abdurrahman Kara

doi:10.5606/tgkdc.dergisi.2018.15489

Frequency of development of aspirin resistance in the early postoperative period and inadequate inhibition of thromboxane A2 production after coronary artery bypass surgery

Turk Gogus Kalp Damar Cerrahisi Derg. 2018 Sep 16;26(4):536-543. doi: 10.5606/tgkdc.dergisi.2018.15489. eCollection 2018 Oct.

Authors

Hayrettin Özkan¹, İlker Kiriş², Şenol Gülmen³, Hüseyin Okutan⁴, Filiz Alkaya Solmaz⁵, Kenan Abdurrahman Kara⁶

Affiliations

¹ Department of Cardiovascular Surgery, Kepez State Hospital, Antalya, Turkey.
² Department of Cardiovascular Surgery, Private Medifema Hospital, İzmir, Turkey.
³ Department of Cardiovascular Surgery, Medicine Faculty of Süleyman Demirel University, Isparta, Turkey.
⁴ Department of Cardiovascular Surgery, Private Medical Park Hospital, Antalya, Turkey.
⁵ Department of Anesthesiology and Reanimation, Medicine Faculty of Süleyman Demirel University, Isparta, Turkey.
⁶ Department of Cardiovascular Surgery, Private Hisar Hospital, İstanbul, Turkey.

Abstract

Background: This study aims to investigate the frequency of the development of aspirin resistance, whether or not this resistance was reversible, and to evaluate the efficiency of the mechanism of incomplete inhibition of thromboxane A2 in development of aspirin resistance in the early postoperative period in patients who had undergone coronary artery bypass grafting.

Methods: Eighty patients (55 males, 25 females; mean age 63.1±9.2 years; range 51 to 75 years) who underwent coronary artery bypass grafting between February 2009 and March 2010 at our clinic were prospectively evaluated. Venous blood samples were collected from all patients and evaluated by a platelet function analyzer in the preoperative period and on postoperative days 7 and 15. Aspirin resistance diagnosis was defined as collagen-epinephrine closure time less than 186 seconds. The urine levels of 11-dehidro thromboxane B2 were also measured on postoperative day one.

Results: Aspirin resistance was found in 23 patients (28.75%) in the preoperative period, in 31 patients (38.75%) on the postoperative seventh day and in 25 patients (31.25%) on the postoperative 15th day. The urine levels of 11-dehidro thromboxane B2 in patients with aspirin resistance on the postoperative seventh day were significantly higher than those in patients without aspirin resistance (p<0.001). The mean aortic cross-clamping time (p=0.003) and cardiopulmonary bypass time (p=0.029) in the patients with aspirin resistance on the postoperative seventh day were significantly higher than those in patients without aspirin resistance.

Conclusion: The results of this study suggest that aspirin resistance develops within the first seven days after coronary artery bypass grafting and is highly reversible, and that the mechanism of inadequate inhibition of thromboxane A2 by aspirin has a role in the development of aspirin resistance in the early postoperative period.

Keywords: Aspirin resistance; coronary artery bypass graft; platelet function analyzer-100; thromboxane A2.