Testing for Aspirin Resistance in Pediatric Patients with Single Ventricle and Ductal Stented Cardiac Disease: A Single Center Quality Improvement Initiative

Aspirin (acetylsalicylic acid, ASA) is the standard of care for thrombosis prevention in patients with single-ventricle physiology and ductal stents. Although weight-based dosing is widely used, there is no consensus on optimal methods to assess adequate platelet inhibition. While platelet inhibition testing was available at our institution, utilization was infrequent, and a standardized approach was lacking. Clinical events prompted interest in systematic application of testing in this population. We applied quality improvement methodology to implement VerifyNow Aspirin (VN) testing to evaluate platelet inhibition in this high-risk cohort. Initial barriers included limited awareness of test availability, miscommunication regarding age eligibility, and inadequate electronic medical record support. Through iterative Plan-Do-Study-Act cycles, VN testing completion increased from 25 to 87% of eligible patients. Observed rates of ASA resistance were consistent with published literature, and dose adjustments achieved adequate platelet inhibition in 93% of patients. This project demonstrated the feasibility of routine assessment of ASA responsiveness in a vulnerable pediatric cardiac population. Future studies should evaluate the association between platelet inhibition and clinical thrombosis outcomes.