Siwik Dominika, Gajewska Magdalena, Karoń Katarzyna, Pluta Kinga, Wondołkowski Mateusz, Wilimski Radosław, Szarpak Łukasz, Filipiak Krzysztof J, Gąsecka Aleksandra
1st Chair and Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland.
Department of Cardiac Surgery, Medical University of Warsaw, 02-097 Warsaw, Poland.
J Clin Med. 2021 May 26;10(11):2317. doi: 10.3390/jcm10112317.
Acetylsalicylic acid (ASA) is one of the most frequently used medications worldwide. Yet, the main indications for ASA are the atherosclerosis-based cardiovascular diseases, including coronary artery disease (CAD). Despite the increasing number of percutaneous procedures to treat CAD, coronary artery bypass grafting (CABG) remains the treatment of choice in patients with multivessel CAD and intermediate or high anatomical lesion complexity. Taking into account that CABG is a potent activator of inflammation, ASA is an important part in the postoperative therapy, not only due to ASA antiplatelet action, but also as an anti-inflammatory agent. Additional benefits of ASA after CABG include anticancerogenic, hypotensive, antiproliferative, anti-osteoporotic, and neuroprotective effects, which are especially important in patients after CABG, prone to hypertension, graft occlusion, atherosclerosis progression, and cognitive impairment. Here, we discuss the pleiotropic effects of ASA after CABG and provide insights into the mechanisms underlying the benefits of treatment with ASA, beyond platelet inhibition. Since some of ASA pleiotropic effects seem to increase the risk of bleeding, it could be considered a starting point to investigate whether the increase of the intensity of the treatment with ASA after CABG is beneficial for the CABG group of patients.
乙酰水杨酸（ASA）是全球使用最频繁的药物之一。然而，ASA的主要适应证是基于动脉粥样硬化的心血管疾病，包括冠状动脉疾病（CAD）。尽管治疗CAD的经皮手术数量不断增加，但冠状动脉旁路移植术（CABG）仍然是多支血管CAD且解剖病变复杂性为中度或高度患者的首选治疗方法。考虑到CABG是炎症的强效激活剂，ASA不仅因其抗血小板作用，还作为一种抗炎剂，是术后治疗的重要组成部分。CABG术后ASA的额外益处包括抗癌、降压、抗增殖、抗骨质疏松和神经保护作用，这对CABG术后易患高血压、移植物闭塞、动脉粥样硬化进展和认知障碍的患者尤为重要。在此，我们讨论CABG术后ASA的多效性作用，并深入探讨ASA治疗益处的潜在机制，这超出了血小板抑制作用。由于ASA的一些多效性作用似乎会增加出血风险，因此可以将其作为一个起点，研究CABG术后增加ASA治疗强度是否对CABG患者有益。
