Over-expression of cyclooxygenase-2 in increased reticulated platelets leads to aspirin resistance after elective off-pump coronary artery bypass surgery. Issue 160 (December 2017)

• Record Type: Journal Article
• Authors: Gong, Xiaoxuan; Wang, Xuezhong; Xu, Zhuowen; Zhu, Tiantian; Zhang, Qiu; Zhang, Jinying; Wang, Xiaowei; Li, Chunjian
• Is Part Of: Thrombosis research. Issue 160(2017)
• Page Start: 114
• Page End: 118
• Publication Date: 2017-12
• Subjects: Coronary artery disease (CAD) -- Aspirin resistance (AR) -- Cyclooxygenase (COX) -- Off-pump coronary artery bypass (OPCAB); Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2017.11.003
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Introduction: Aspirin resistance (AR) has been reported to present after coronary artery bypass graft causing saphenous vein graft failure. We aimed to investigate the factors that affect the anti-platelet effect of aspirin after off-pump coronary artery bypass surgery (OPCAB). Materials and methods: Thirty OPCAB candidates were successively recruited. Platelet count, platelet aggregation, reticulated platelet (RP), platelets' cyclooxygenase (COX)-1 and COX-2 expressions were determined during the peri-operative period. Besides, 10 healthy volunteers were enrolled to determine the onset of the anti-platelet effect of aspirin as comparison. Results and conclusions: The arachidonic acid-induced platelet aggregation (PLAA ) decreased to < 20% within 8 h after taking 100 mg aspirin in healthy volunteers. However, in the OPCAB patients, PLAA levels remained over 20% in 16 (53.3%) patients after resuming aspirin for 24 h. The surgical bleeding volumes were higher in the AR patients compared to the normal responders (512.5 ± 192.8 vs . 314.3 ± 94.9, p = 0.002). The platelet count on Day 8, RP proportions on Days 1, 4, 8, and COX-2 level on Day 4 were significantly increased compared to their baseline levels in AR group but not in AS group. Platelet count on Day 8, RP proportion and COX-2 on Day 4 were all significantly higher in AR group than those in AS group. The surgical bleeding volume and COX-2 over-expression were predictors of post-OPCAB AR. As a conclusion, the inability of aspirin to inhibit the COX-2 created by increased RP would account for the post-OPCAB AR. Highlights: Aspirin resistance (AR) occurs in 53.3% patients after OPCAB. Post-OPCAB AR occurs within 3 days and vanishes within 7 days after OPCAB. The surgical bleeding and COX-2 over-expression are risk factors of post-OPCAB AR.