Willemsen Laura M, Vlot Eline A, Janssen Paul W A, Visser Claire D, Zheng Kai, Kelder Johannes C, Noordzij Peter G, van den Dool Erik-Jan, Klein Patrick, Hackeng Christian M, Ten Berg Jurrien M
Department of Cardiology St Antonius Hospital Nieuwegein The Netherlands.
Department of Anesthesiology, Intensive Care, and Pain Medicine St Antonius Hospital Nieuwegein The Netherlands.
Res Pract Thromb Haemost. 2021 Dec 27;5(8):e12623. doi: 10.1002/rth2.12623. eCollection 2021 Dec.
Aspirin is important for preventing thrombotic events but also increases bleeding complications. Minimizing bleeding while preventing thrombotic events remains challenging in patients undergoing coronary artery bypass grafting (CABG). Establishing the patient's preoperative aspirin response could distinguish patients at risk for perioperative blood loss.
Aim was to compare 12-h blood loss after CABG between aspirin-sensitive and aspirin-resistant patients.
PATIENTS/METHODS: The primary analysis of this substudy of the POPular CABG trial (NCT02352402) included patients that used aspirin monotherapy preoperatively. A preoperative platelet function test by the VerifyNow aspirin assay was performed before CABG and patients were classified as aspirin-sensitive or aspirin-resistant based on an aspirin reaction units cutoff value of 550. The primary end point was 12-hour blood loss after CABG. The secondary end point was, among others, clinical bleeding events after CABG.
A total of 128 patients were included in the primary analysis. Of these, 116 patients were aspirin sensitive and 12 were aspirin resistant. Mean blood loss 12 hours after CABG was 555 ± 278 mL in aspirin-sensitive patients and 406±110 mL in aspirin-resistant patients (= .04). All bleeding events (n = 15; 11.7%) occurred in aspirin-sensitive patients.
In patients who are on aspirin preoperatively, aspirin sensitivity was associated with 12-hour blood loss after CABG, suggesting that preoperative VerifyNow aspirin testing could identify patients undergoing CABG at high risk for perioperative bleeding.
阿司匹林对于预防血栓形成事件很重要，但也会增加出血并发症。在接受冠状动脉旁路移植术（CABG）的患者中，在预防血栓形成事件的同时尽量减少出血仍然具有挑战性。确定患者术前的阿司匹林反应可以区分围手术期失血风险较高的患者。
旨在比较阿司匹林敏感和阿司匹林抵抗患者CABG术后12小时的失血量。
患者/方法：这项对POPular CABG试验（NCT02352402）的子研究的主要分析纳入了术前使用阿司匹林单药治疗的患者。在CABG术前通过VerifyNow阿司匹林检测进行术前血小板功能测试，并根据阿司匹林反应单位临界值550将患者分为阿司匹林敏感或阿司匹林抵抗。主要终点是CABG术后12小时的失血量。次要终点包括CABG术后的临床出血事件等。
共有128例患者纳入主要分析。其中，116例患者对阿司匹林敏感，12例患者对阿司匹林抵抗。阿司匹林敏感患者CABG术后12小时的平均失血量为555±278 mL，阿司匹林抵抗患者为406±110 mL（P = 0.04）。所有出血事件（n = 15；11.7%）均发生在阿司匹林敏感患者中。
在术前服用阿司匹林的患者中，阿司匹林敏感性与CABG术后12小时的失血量相关，这表明术前VerifyNow阿司匹林检测可以识别接受CABG手术围手术期出血风险较高的患者。
