Kuliczkowski Wiktor, Golanski Ryszard, Bijak Michal, Boryczka Katarzyna, Kaczmarski Jacek, Watala Cezary, Golanski Jacek
aDepartment of Cardiology, Wroclaw Medical University, Wroclaw bDepartment of Cardiac Surgery, Medical University of Lodz cDepartment of General Biochemistry, Faculty of Biology and Environmental Protection, University of Lodz dSilesian Center for Heart Diseases, Zabrze eDepartment of Haemostasis and Haemostatic Disorders, Medical University of Lodz, Lodz, Poland.
Blood Coagul Fibrinolysis. 2016 Mar;27(2):151-5. doi: 10.1097/MBC.0000000000000396.
The aim of the study was to assess the responsiveness of blood platelets to acetylsalicylic acid (ASA) in patients following coronary artery bypass grafting (CABG) surgery with relation to oxidative and antioxidative plasma status. The study included 37 patients treated with the CABG procedure. During the first 24 h after CABG patients were given 300 mg of ASA with the following dose of 150 mg daily. The blood was collected before the procedure and 10 days after. Whole blood platelet aggregation induced with arachidonic acid, collagen and adenosine diphosphate (ADP) was performed together with whole blood generation of thromboxane B2 (TxB2). Oxidative stress was measured before and 10 days after CABG with total oxidative plasma status (TOS) and total antioxidative status of the plasma (TAS). TOS/TAS index was calculated. We observed a significant increase in the TOS and TOS/TAS index and ADP-induced aggregation 10 days after CABG in comparison with its level before operation. There was a significant decrease in the arachidonic acid-induced aggregation and serum TxB2 level. Patients with ADP-induced and collagen-induced aggregation in the upper quartile had significantly higher TOS and TOS/TAS index before (ADP) and after the operation (ADP and collagen). There were 19 patients (51%) with high on aspirin platelet reactivity after CABG who had also higher TOS and TOS/TAS index and lower TAS value in comparison with aspirin responders. Despite ASA use, increased oxidative stress after CABG can overcome its antiplatelet effect and increase platelet activation through other pathways.
本研究的目的是评估冠状动脉旁路移植术（CABG）后患者血小板对乙酰水杨酸（ASA）的反应性及其与血浆氧化和抗氧化状态的关系。该研究纳入了37例行CABG手术的患者。CABG术后的头24小时内，患者服用300mg ASA，之后每日服用150mg。分别在手术前和术后10天采集血液。检测用花生四烯酸、胶原和二磷酸腺苷（ADP）诱导的全血血小板聚集以及全血血栓素B2（TxB2）的生成情况。在CABG术前和术后10天，通过血浆总氧化状态（TOS）和血浆总抗氧化状态（TAS）来测定氧化应激，并计算TOS/TAS指数。我们观察到，与术前水平相比，CABG术后10天TOS、TOS/TAS指数以及ADP诱导的聚集均显著增加。花生四烯酸诱导的聚集和血清TxB2水平则显著降低。术前（ADP）和术后（ADP和胶原），处于上四分位数的ADP诱导和胶原诱导聚集的患者，其TOS和TOS/TAS指数显著更高。CABG术后有19例患者（51%）对阿司匹林的血小板反应性较高，与阿司匹林反应者相比，他们的TOS和TOS/TAS指数更高，而TAS值更低。尽管使用了ASA，但CABG术后氧化应激增加可抵消其抗血小板作用，并通过其他途径增加血小板活化。
