Interdisciplinary Medicine in Cardiology Unit, University of São Paulo Medical School, São Paulo, Brazil.
J Vasc Surg. 2013 Dec;58(6):1593-9. doi: 10.1016/j.jvs.2013.06.061.
Vascular surgeries are related to high cardiac morbidity and mortality, and the maintenance of aspirin in the perioperative period has a protective effect. The purpose of this study was to evaluate the association between preoperative platelet aggregability and perioperative cardiovascular (CV) events.
A preoperative platelet aggregation test was performed on an impedance aggregometer in response to collagen and to arachidonic acid (AA) for 191 vascular surgery patients under chronic use of aspirin. We analyzed the following CV events: acute myocardial infarction, unstable angina, isolated troponin elevation, acute ischemic stroke, reoperation, and cardiac death. Hemorrhagic events were also evaluated and classified according to the Thrombolysis In Myocardial Infarction criteria.
The incidence of CV events was 22% (n = 42). Higher platelet response to AA was associated with CV events, so that patients in the fourth quartile (higher than 11Ω) had almost twice the incidence of CV events when compared with the three lower quartiles: 35% vs 19%; P = .025. The independent predictors of CV events were hemodynamic instability during anesthesia (odds ratio [OR], 4.12; 95% confidence interval [CI], 1.87-9.06; P < .001), dyslipidemia (OR, 3.9; 95% CI, 1.32-11.51; P = .014), preoperative anemia (OR, 2.64; 95% CI, 1.19-5.85; P = .017), and AA platelet aggregability in the upper quartile (OR, 2.48; 95% CI, 1.07-5.76; P = .034). Platelet aggregability was not associated with hemorrhagic events, even when we compared the lowest quartile of AA platelet aggregability (0-1.00 Ω) with the three upper quartiles (>1.00 Ω; OR, 0.77; 95% CI, 0.43-1.37; P = .377).
The degree of aspirin effect on platelet aggregability maybe important in the management of perioperative CV morbidity, without increment in the bleeding toll.
血管手术与较高的心脏发病率和死亡率有关，围手术期维持阿司匹林具有保护作用。本研究旨在评估术前血小板聚集性与围手术期心血管（CV）事件之间的关系。
对 191 例长期服用阿司匹林的血管手术患者，使用阻抗凝集仪进行胶原和花生四烯酸（AA）刺激的术前血小板聚集试验。我们分析了以下 CV 事件：急性心肌梗死、不稳定型心绞痛、孤立性肌钙蛋白升高、急性缺血性卒中、再次手术和心脏死亡。还根据溶栓治疗心肌梗死标准评估并分类出血事件。
CV 事件发生率为 22%（n=42）。AA 反应性较高的血小板与 CV 事件相关，因此第 4 四分位（高于 11Ω）的患者发生 CV 事件的几率几乎是第 3 个四分位以下患者的两倍：35%比 19%；P=0.025。CV 事件的独立预测因素包括麻醉期间血流动力学不稳定（优势比[OR]，4.12；95%置信区间[CI]，1.87-9.06；P<0.001）、血脂异常（OR，3.9；95%CI，1.32-11.51；P=0.014）、术前贫血（OR，2.64；95%CI，1.19-5.85；P=0.017）和 AA 血小板聚集性在上四分位（OR，2.48；95%CI，1.07-5.76；P=0.034）。血小板聚集性与出血事件无关，即使我们将 AA 血小板聚集性的最低四分位数（0-1.00Ω）与三个较高四分位数（>1.00Ω）进行比较（OR，0.77；95%CI，0.43-1.37；P=0.377）。
阿司匹林对血小板聚集性的抑制程度可能对围手术期 CV 发病率的管理很重要，而不会增加出血风险。
