Key result
Vascular procedures linked to a ~110% increase in postoperative aspirin low-response.
Why the study?
Prevalence data for aspirin or clopidogrel low-responders vary widely, with few investigations in high-risk vascular surgery patients to evaluate changes after common vascular procedures.
Does vascular surgery alter the response to aspirin or clopidogrel in patients with peripheral artery disease or carotid stenosis?
Observational (n=176)
No
Does vascular surgery alter the response to aspirin or clopidogrel in patients with peripheral artery disease or carotid stenosis?
Vascular surgery significantly increases the incidence of reduced aspirin response postoperatively, which is associated with elevated platelet counts and may impact thromboembolic risk.
Answers are grounded in this paper and cite their sources.
May heighten perioperative thromboembolic risk in PAD; leaves open whether platelet testing or regimen adjustment improves outcomes.
INTRODUCTION: Reduced antiplatelet activity of aspirin (ALR) or clopidogrel (CLR) is associated with an increased risk of thromboembolic events. The reported prevalence data for low-responders vary widely and there have been few investigations in vascular surgery patients even though they are at high risk for thromb-embolic complications. The aim of this prospective observational monocentric study was to elucidate possible changes in ALR or CLR after common vascular procedures. METHODS: Activity of aspirin and clopidogrel was measured by impedance aggregometry using a multiple electrode aggregometer (Multiplate®). Possible risk factors for ALR or CLR were identified by demographical, clinical data and laboratory parameters. In addition, a follow-up aggregometry was performed after completion of the vascular procedure to identify changes in antiplatelet response. RESULTS: A total of 176 patients taking antiplatelet medications aspirin and/or clopidogrel with peripheral artery disease (PAD) and/or carotid stenosis (CS) were included in the study. The prevalence of ALR was 13.1% and the prevalence of CLR was 32% in the aggregometry before vascular treatment. Potential risk factors identified in the aspirin group were concomitant insulin medication (p = 0.0006) and elevated C-reactive protein (CRP) (p = 0.0021). The overall ALR increased significantly postoperatively to 27.5% (p = 0.0006); however, there was no significant change in CLR that was detected. In a subgroup analysis elevation of the platelet count was associated with a post-procedure increase of ALR incidence. CONCLUSION: The incidence of ALR in vascular surgery patients increases after vascular procedures. An elevated platelet count was detected as a risk factor. Further studies are necessary to analyse this potential influence on patency rates of vascular reconstructions.
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Hummel et al. (2020) conducted an observational in Peripheral artery disease (PAD) and/or carotid stenosis (CS) (n=176). Vascular procedures vs. Preoperative baseline was evaluated on Prevalence of aspirin low-response (ALR) (p=0.0006). Vascular procedures increased the prevalence of aspirin low-response from 13.1% preoperatively to 27.5% postoperatively.
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