Häufigkeit und Auswirkungen der ASS Non-Response bei kardiochirurgischen Patienten

Häufigkeit und Auswirkungen der ASS Non-Response bei kardiochirurgischen Patienten

The Prevalence and Clinical Relevance of ASA Nonresponse after Cardiac Surgery

Lisa Huber-Petersen

Doctoral thesis

Date of Examination: 2018-01-23

Date of issue: 2018-01-04

Advisor: Bauer, Martin Prof. Dr. Dr.

Referee: Bauer, Martin Prof. Dr. Dr.

Referee: Legler, Tobias Prof. Dr.

Persistent Address: http://hdl.handle.net/11858/00-1735-0000-002E-E313-1

Files in this item

Name: Dissertation_Endversion Online.pdf

Size: 1,2 MB

Format: PDF

View/Open

The following license files are associated with this item:

Creative Commons

Abstract

English

Coronary artery disease (CAD) is accompanied with high morbidity and mortality that can be treated with a revascularization procedure. Nearly all patients receive acetylsalicylic acid (ASA) for secondary prevention of major cardiac or cerebrovascular events. ASA inhibits platelet activation and reduces thromboembolic complications, but a sufficient inhibition of platelet function is not always achieved. The aim of the study was to identify the prevalence of ASA nonresponse in patients after coronary artery bypass graft (CABG) surgery and the possible consequences for the rate of major cardiovascular events. A total of 200 patients undergoing elective CABG surgery that took 100mg of ASA postoperatively were enrolled. The platelet function was analyzed on 3rd and 5th postoperative day. Platelet activation was measured by multiple electrode aggregometry (Multiplate). Platelet aggregation was stimulated with arachidonic acid (ASPItest) and with thrombin receptor-activiating peptide 6 (TRAPtest). Categorizing patients with an ASPItest > 40 AU*min as nonresponders, the prevalence of ASA nonresponse was 62.5% on 3rd postoperative day and 76.5% on 5th postoperative day. Statistical analysis could not identify a soziodemgraphic or clinical factor that has reached statistical relevant difference between the groups. A one year follow up recorded 23 events as combined endpoints (cardiovascular events, hospital admission or deaths related to cardiovascular disease). There was no effect on the incidence of events in comparison of ASA responders and ASA nonresponders.

Keywords: ASA nonresponse; multiple electrode aggregometry; platelet function; cardiac surgery