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Eur J Cardiothorac Surg 2005;28:514
© 2005 Elsevier Science NL

Letter to the Editor

Platelet function tests predict bleeding and thrombotic events after off-pump coronary bypass grafting

^a Marmara University School of Medicine, Istanbul, Turkey
^b Academic Hospital Istanbul, Istanbul, Turkey

Received 25 April 2005; accepted 9 May 2005.

^* Corresponding author. Address: Cardiovascular Surgery, Marmara University Hospital, Orhan Ersek sok. 27/2 d:20 Nisantas, Istanbul, Turkey. Fax: +90 216 4285777. (Email: isbir{at}yahoo.com).

Key Words: Aspirin • Resistance • TEG • Cardiopulmonary • Bypass • CABG • Off-pump

We read with great interest the article entitled ‘Platelet function tests predict bleeding and thrombotic events after off-pump coronary bypass grafting’ written by Poston and colleagues [1]. Platelet function and bleeding is still a big challenge in cardiac surgery. We certainly agree with Poston and colleagues with regard to their comments on TEG-based algorhytma.

Our group is now routinely using TEG for screening the coagulation during surgery. We also initially obtain basal TEG analysis before skin incision in all our coronary patients. We routinely do not stop the aspirin before surgery. Therefore, we have a chance to plan our postoperative anti-aggregan therapy. We found so called 30% aspirin resistance in our patients compared to nearly 10% in your series. We think that this high number might be due to nonspecific kits for aspirin resistance we used in routine. But we do confirm the TEG with aggregometry. As far as to our knowledge there is no single test that definitely shows the aspirin resistance. We think that Aspirin resistance is extremely important issue in Cardiovascular disorders. However, there is no consensus in how to describe Aspirin resistance. The frequency is highly variable like 5–40% in literature [2–4].

We therefore start clopidogrel 6h after surgery in patients suspicious to have Aspirin resistance before we confirm it with aggregometry, if the patient does not have any excess in chest tube drainage. We believe that this is very important in maintenance of early graft patency. So far we have not seen any side effects due to clopidogrel other than skin eruptions in few patients.

It was not clear in the article as to why the aspirin resistance was diagnosed in POD 3. We think that aspirin resistance is a very important issue in terms of graft patency, not only in Off-Pump patients but also in On-Pump patients. Therefore, do the authors think whether should we start clopidogrel to all our initial suspicious patients or should we wait till we get more accurate results. Our policy is to start clopidogrel as soon as possible in patients who are suspicious to have Aspirin resistance.

In conclusion, aspirin resistance is an important issue and should be considered in all patients with coronary disease. TEG is a useful tool in preoperative screening. It has the advantage of simplicity and is relatively cheap. If the patient is suspicious to have aspirin resistance additional anti-aggregan therapies should be started as quickly as possible.

References

1. Poston R, Gu J, Manchio J, Lee A, Brown J, Gammie J, White C, Griffith BP. Platelet function tests predict bleeding and thrombotic events after off-pump coronary bypass grafting. Eur J Cardiothorac Surg 2005;27(4):584-591.[Abstract/Free Full Text]
2. Sanderson S, Emery J, Baglin T, Kinmonth AL. Narrative review: aspirin resistance and its clinical implications. Ann Intern Med 2005;142(5):370-380.[Abstract/Free Full Text]
3. Mason PJ, Freedman JE, Jacobs AK. Aspirin resistance: current concepts. Rev Cardiovasc Med 2004;5(3):156-163.[CrossRef][Medline]
4. Ambrus JL, Ambrus CM, Akhter S. Aspirin "allergy" and resistance. J Am Coll Cardiol 2004;44(4):939-940.[Free Full Text]

This article has been cited by other articles:

				R. Poston and B. Griffith Reply to Isbir et al. Eur. J. Cardiothorac. Surg., September 1, 2005; 28(3): 514 - 515. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Selim Isbir Koray Ak Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Isbir, S. Articles by Aksoy, N. Search for Related Content PubMed PubMed Citation Articles by Isbir, S. Articles by Aksoy, N. Related Collections Cardiac - pharmacology Cardiac - other Coronary disease Extracorporeal circulation