OBJECTIVES: Changes in hemostasis after off-pump coronary artery bypass grafting are still being discussed. There is a lack of information about platelet activity and aspirin efficacy after coronary artery bypass grafting. The aim of this study was to assess and compare platelet activity and aspirin efficacy early and late after off-pump and on-pump coronary artery bypass grafting. METHODS: Eighty patients were enrolled in a prospective randomized study. Platelet activity was determined based on membrane expression of antigen CD62P (P-selectin) by means of flow cytometric analysis. Aspirin efficacy was assessed by using arachidonic acid-induced platelet aggregation. Blood samples were collected before the operation, immediately postoperatively, and on days 1, 2, 5, and 30. RESULTS: In the off-pump group expression of P-selectin was markedly increased in comparison with preoperative values, with a maximum difference observed on day 2 (+53%, P = .02), and it was significantly higher compared with that seen in the on-pump group on days 2 and 5 (+53% vs +4%, P = .004, and +20% vs -16%, P = .005). On day 30, P-selectin expression was similar both between the groups and in comparison with the preoperative values. Arachidonic acid-induced platelet aggregation was gradually decreasing until day 30, but on day 2, there was an unexpected increase in aggregation that was more expressed in the off-pump group. CONCLUSIONS: The platelet activity is higher in the early postoperative period in off-pump compared with on-pump coronary artery bypass grafting. The present aspirin strategy seems to be insufficient in the early postoperative period, irrespective of the surgical technique used.
- MeSH
- Survival Analysis MeSH
- Aspirin administration & dosage MeSH
- Financing, Organized MeSH
- Risk Assessment MeSH
- Confidence Intervals MeSH
- Coronary Artery Bypass, Off-Pump methods adverse effects MeSH
- Coronary Artery Bypass methods adverse effects MeSH
- Coronary Stenosis diagnosis surgery mortality MeSH
- Middle Aged MeSH
- Humans MeSH
- P-Selectin analysis MeSH
- Postoperative Care MeSH
- Probability MeSH
- Preoperative Care MeSH
- Graft Survival MeSH
- Prognosis MeSH
- Prospective Studies MeSH
- Graft Rejection MeSH
- Drug Administration Schedule MeSH
- Aged MeSH
- Thromboplastin metabolism MeSH
- Treatment Outcome MeSH
- Dose-Response Relationship, Drug MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Randomized Controlled Trial MeSH
BACKGROUND : Inconsistent findings are reported about the relation of platelet activity to disease severity in stable patients with chronic coronary artery disease (CAD). Nevertheless, most reports studied only very small groups of patients. The purpose aim of our study was to assess the relation of platelet activity to disease severity in sufficient number of patients with chronic CAD. METHODS : One hundred and sixty stable patients with chronic CAD were studied (25 with single-, 63 with double- and 72 with triple-vessel disease). 91% of them were on aspirin, 1.6% on clopidogrel medication. Platelet activity was determined as membrane expression of antigens CD62P (P-selectin, as % of positive cells) and CD41 (part of GpIIb/IIIa integrin, as mean fluorescence intensity) by flow cytometry. Platelet aggregability was measured by ADP-optical aggregometry. Data sets were compared by Kruskal-Wallis test, correlation by Spearman test. Data are shown as median with 25-75 percentiles. RESULTS : Membrane CD62P expression correlated with vessel severity (P < 0.001, Kruskal-Wallis test). Patients with triple-vessel disease had the highest CD62P expression (1.6; 1.1-2.0) followed by patients with double-vessel (1.2; 0.63-1.95) and single-vessel (0.7; 0.30-0.84) disease. Positive correlation was found between CD62P expression with triglycerides (r = 0.49, P < 0.05) and CD41 with fasting glucose (r = 0.48, P < 0.05). No differences in CD41 expression or ADP aggregability were found between groups. CONCLUSION : Higher platelet activity is present in patients with more severe CAD. More aggressive anti-platelet treatment in these patients should be considered, especially when metabolic syndrome is simultaneously present.
- MeSH
- Adenosine Diphosphate pharmacology MeSH
- Platelet Activation MeSH
- Financing, Organized MeSH
- Blood Glucose analysis MeSH
- Middle Aged MeSH
- Humans MeSH
- Metabolic Syndrome blood MeSH
- Coronary Artery Disease blood metabolism MeSH
- P-Selectin analysis MeSH
- Aged MeSH
- Severity of Illness Index MeSH
- Triglycerides blood MeSH
- Platelet Membrane Glycoprotein IIb analysis MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- MeSH
- Endothelium, Vascular physiopathology MeSH
- Cholesterol analysis classification blood MeSH
- Diabetes Mellitus, Type 2 complications metabolism MeSH
- Research Support as Topic MeSH
- Blood Glucose analysis MeSH
- Humans MeSH
- Metabolic Syndrome complications metabolism MeSH
- P-Selectin analysis contraindications MeSH
- Hydroxymethylglutaryl-CoA Reductase Inhibitors metabolism therapeutic use MeSH
- Check Tag
- Humans MeSH
- Publication type
- Congress MeSH
- MeSH
- Heart Septal Defects, Atrial diagnosis surgery blood MeSH
- Child MeSH
- E-Selectin blood MeSH
- Cardiac Surgical Procedures methods MeSH
- Cardiopulmonary Bypass methods MeSH
- Humans MeSH
- Membrane Glycoproteins analysis MeSH
- P-Selectin analysis contraindications MeSH
- Heart Defects, Congenital MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Publication type
- Comparative Study MeSH
