Blood loss after coronary artery bypass by aspirin responsiveness assessed with preoperative VerifyNow aspirin testing

Laura M Willemsen; Eline A Vlot; Paul W A Janssen; Claire D Visser; Kai Zheng; Johannes C Kelder; Peter G Noordzij; Erik-Jan van den Dool; Patrick Klein; Christian M Hackeng; Jurrien M Ten Berg

doi:10.1002/rth2.12623

Blood loss after coronary artery bypass by aspirin responsiveness assessed with preoperative VerifyNow aspirin testing

Laura M Willemsen^*, Eline A Vlot, Paul W A Janssen, Claire D Visser, Kai Zheng, Johannes C Kelder, Peter G Noordzij, Erik-Jan van den Dool, Patrick Klein, Christian M Hackeng, Jurrien M Ten Berg

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Aspirin is important for preventing thrombotic events but also increases bleeding complications. Minimizing bleeding while preventing thrombotic events remains challenging in patients undergoing coronary artery bypass grafting (CABG). Establishing the patient's preoperative aspirin response could distinguish patients at risk for perioperative blood loss.

OBJECTIVE: Aim was to compare 12-h blood loss after CABG between aspirin-sensitive and aspirin-resistant patients.

PATIENTS/METHODS: The primary analysis of this substudy of the POPular CABG trial (NCT02352402) included patients that used aspirin monotherapy preoperatively. A preoperative platelet function test by the VerifyNow aspirin assay was performed before CABG and patients were classified as aspirin-sensitive or aspirin-resistant based on an aspirin reaction units cutoff value of 550. The primary end point was 12-hour blood loss after CABG. The secondary end point was, among others, clinical bleeding events after CABG.

RESULTS: A total of 128 patients were included in the primary analysis. Of these, 116 patients were aspirin sensitive and 12 were aspirin resistant. Mean blood loss 12 hours after CABG was 555 ± 278 mL in aspirin-sensitive patients and 406±110 mL in aspirin-resistant patients (P = .04). All bleeding events (n = 15; 11.7%) occurred in aspirin-sensitive patients.

CONCLUSIONS: In patients who are on aspirin preoperatively, aspirin sensitivity was associated with 12-hour blood loss after CABG, suggesting that preoperative VerifyNow aspirin testing could identify patients undergoing CABG at high risk for perioperative bleeding.

Original language	English
Article number	e12623
Journal	Research and practice in thrombosis and haemostasis
Volume	5
Issue number	8
DOIs	https://doi.org/10.1002/rth2.12623
Publication status	Published - Dec 2021
Externally published	Yes

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10.1002/rth2.12623

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Willemsen, L. M., Vlot, E. A., Janssen, P. W. A., Visser, C. D., Zheng, K., Kelder, J. C., Noordzij, P. G., van den Dool, E.-J., Klein, P., Hackeng, C. M., & Ten Berg, J. M. (2021). Blood loss after coronary artery bypass by aspirin responsiveness assessed with preoperative VerifyNow aspirin testing. Research and practice in thrombosis and haemostasis, 5(8), Article e12623. https://doi.org/10.1002/rth2.12623

@article{b1f3bf8923644d2ea4a91c3d54dc8c8c,

title = "Blood loss after coronary artery bypass by aspirin responsiveness assessed with preoperative VerifyNow aspirin testing",

abstract = "BACKGROUND: Aspirin is important for preventing thrombotic events but also increases bleeding complications. Minimizing bleeding while preventing thrombotic events remains challenging in patients undergoing coronary artery bypass grafting (CABG). Establishing the patient's preoperative aspirin response could distinguish patients at risk for perioperative blood loss.OBJECTIVE: Aim was to compare 12-h blood loss after CABG between aspirin-sensitive and aspirin-resistant patients.PATIENTS/METHODS: The primary analysis of this substudy of the POPular CABG trial (NCT02352402) included patients that used aspirin monotherapy preoperatively. A preoperative platelet function test by the VerifyNow aspirin assay was performed before CABG and patients were classified as aspirin-sensitive or aspirin-resistant based on an aspirin reaction units cutoff value of 550. The primary end point was 12-hour blood loss after CABG. The secondary end point was, among others, clinical bleeding events after CABG.RESULTS: A total of 128 patients were included in the primary analysis. Of these, 116 patients were aspirin sensitive and 12 were aspirin resistant. Mean blood loss 12 hours after CABG was 555 ± 278 mL in aspirin-sensitive patients and 406±110 mL in aspirin-resistant patients (P = .04). All bleeding events (n = 15; 11.7%) occurred in aspirin-sensitive patients.CONCLUSIONS: In patients who are on aspirin preoperatively, aspirin sensitivity was associated with 12-hour blood loss after CABG, suggesting that preoperative VerifyNow aspirin testing could identify patients undergoing CABG at high risk for perioperative bleeding.",

author = "Willemsen, {Laura M} and Vlot, {Eline A} and Janssen, {Paul W A} and Visser, {Claire D} and Kai Zheng and Kelder, {Johannes C} and Noordzij, {Peter G} and {van den Dool}, Erik-Jan and Patrick Klein and Hackeng, {Christian M} and {Ten Berg}, {Jurrien M}",

note = "Publisher Copyright: {\textcopyright} 2021 The Authors. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis (ISTH).",

year = "2021",

month = dec,

doi = "10.1002/rth2.12623",

language = "English",

volume = "5",

number = "8",

}

Willemsen, LM, Vlot, EA, Janssen, PWA, Visser, CD, Zheng, K, Kelder, JC, Noordzij, PG, van den Dool, E-J, Klein, P, Hackeng, CM & Ten Berg, JM 2021, 'Blood loss after coronary artery bypass by aspirin responsiveness assessed with preoperative VerifyNow aspirin testing', Research and practice in thrombosis and haemostasis, vol. 5, no. 8, e12623. https://doi.org/10.1002/rth2.12623

TY - JOUR

T1 - Blood loss after coronary artery bypass by aspirin responsiveness assessed with preoperative VerifyNow aspirin testing

AU - Willemsen, Laura M

AU - Vlot, Eline A

AU - Janssen, Paul W A

AU - Visser, Claire D

AU - Zheng, Kai

AU - Kelder, Johannes C

AU - Noordzij, Peter G

AU - van den Dool, Erik-Jan

AU - Klein, Patrick

AU - Hackeng, Christian M

AU - Ten Berg, Jurrien M

N1 - Publisher Copyright: © 2021 The Authors. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis (ISTH).

PY - 2021/12

Y1 - 2021/12

N2 - BACKGROUND: Aspirin is important for preventing thrombotic events but also increases bleeding complications. Minimizing bleeding while preventing thrombotic events remains challenging in patients undergoing coronary artery bypass grafting (CABG). Establishing the patient's preoperative aspirin response could distinguish patients at risk for perioperative blood loss.OBJECTIVE: Aim was to compare 12-h blood loss after CABG between aspirin-sensitive and aspirin-resistant patients.PATIENTS/METHODS: The primary analysis of this substudy of the POPular CABG trial (NCT02352402) included patients that used aspirin monotherapy preoperatively. A preoperative platelet function test by the VerifyNow aspirin assay was performed before CABG and patients were classified as aspirin-sensitive or aspirin-resistant based on an aspirin reaction units cutoff value of 550. The primary end point was 12-hour blood loss after CABG. The secondary end point was, among others, clinical bleeding events after CABG.RESULTS: A total of 128 patients were included in the primary analysis. Of these, 116 patients were aspirin sensitive and 12 were aspirin resistant. Mean blood loss 12 hours after CABG was 555 ± 278 mL in aspirin-sensitive patients and 406±110 mL in aspirin-resistant patients (P = .04). All bleeding events (n = 15; 11.7%) occurred in aspirin-sensitive patients.CONCLUSIONS: In patients who are on aspirin preoperatively, aspirin sensitivity was associated with 12-hour blood loss after CABG, suggesting that preoperative VerifyNow aspirin testing could identify patients undergoing CABG at high risk for perioperative bleeding.

AB - BACKGROUND: Aspirin is important for preventing thrombotic events but also increases bleeding complications. Minimizing bleeding while preventing thrombotic events remains challenging in patients undergoing coronary artery bypass grafting (CABG). Establishing the patient's preoperative aspirin response could distinguish patients at risk for perioperative blood loss.OBJECTIVE: Aim was to compare 12-h blood loss after CABG between aspirin-sensitive and aspirin-resistant patients.PATIENTS/METHODS: The primary analysis of this substudy of the POPular CABG trial (NCT02352402) included patients that used aspirin monotherapy preoperatively. A preoperative platelet function test by the VerifyNow aspirin assay was performed before CABG and patients were classified as aspirin-sensitive or aspirin-resistant based on an aspirin reaction units cutoff value of 550. The primary end point was 12-hour blood loss after CABG. The secondary end point was, among others, clinical bleeding events after CABG.RESULTS: A total of 128 patients were included in the primary analysis. Of these, 116 patients were aspirin sensitive and 12 were aspirin resistant. Mean blood loss 12 hours after CABG was 555 ± 278 mL in aspirin-sensitive patients and 406±110 mL in aspirin-resistant patients (P = .04). All bleeding events (n = 15; 11.7%) occurred in aspirin-sensitive patients.CONCLUSIONS: In patients who are on aspirin preoperatively, aspirin sensitivity was associated with 12-hour blood loss after CABG, suggesting that preoperative VerifyNow aspirin testing could identify patients undergoing CABG at high risk for perioperative bleeding.

UR - http://www.scopus.com/inward/record.url?scp=85121849627&partnerID=8YFLogxK

U2 - 10.1002/rth2.12623

DO - 10.1002/rth2.12623

M3 - Article

C2 - 34993386

SN - 2475-0379

VL - 5

JO - Research and practice in thrombosis and haemostasis

JF - Research and practice in thrombosis and haemostasis

IS - 8

M1 - e12623

ER -

Blood loss after coronary artery bypass by aspirin responsiveness assessed with preoperative VerifyNow aspirin testing

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