Impact of aspirin resistance on outcomes among patients following coronary artery bypass grafting: exploratory analysis from randomized controlled trial (NCT01159639)

Petričević, Mate and Kopjar, Tomislav and Gašparović, Hrvoje and Miličić, Davor and Svetina, Lucija and Zdilar, Boris and Boban, Marko and Zrno Mihaljević, Martina and Biočina, Bojan (2015) Impact of aspirin resistance on outcomes among patients following coronary artery bypass grafting: exploratory analysis from randomized controlled trial (NCT01159639). Journal of Thrombosis and Thrombolysis, 39 (4). pp. 522-531. ISSN 0929-5305

[img] PDF - Accepted Version
Download (516kB)


Individual variability in the response to aspirin, has been established by various platelet function assays, however, the clinical relevance of aspirin resistance (AR) in patients undergoing coronary artery bypass grafting (CABG) has to be evaluated. Our working group conducted a randomized controlled trial (NCT01159639) with the aim to assess impact of dual antiplatelet therapy (APT) on outcomes among patients with AR following CABG. Patients that were aspirin resistant on fourth postoperative day (POD 4) were randomly assigned to receive either dual APT with clopidogrel (75 mg) plus aspirin (300 mg)-intervention arm or monotherapy with aspirin (300 mg)-control arm. This exploratory analysis compares clinical outcomes between aspirin resistant patients allocated to control arm and patients that have had adequate platelet inhibitory response to aspirin at POD 4. Both groups were treated with 300 mg of aspirin per day following surgery. We sought to evaluate the impact of early postoperative AR on outcomes among patients following CABG. Exploratory analysis included a total number of 325 patients. Of those, 215 patients with adequate response to aspirin and 110 patients with AR allocated to aspirin monotherapy following randomization protocol. The primary efficacy end point (MACCEs-major adverse cardiac and cardiovascular events) occurred in 10 and 6 % of patients with AR and with adequate aspirin response, respectively (p = 0.27). Non-significant differences were observed in bleeding events occurrence. Subgroup analysis of the primary end point revealed that aspirin resistant patients with BMI > 30 kg/m(2) tend to have a higher occurrence of MACCEs 18 versus 5 % (relative risk 0.44 [95 % CI 0.16-1.16]; p = 0.05). This exploratory analysis did not reveal significant impact of aspirin resistance on outcomes among patients undergoing CABG. Further, sufficiently powered studies are needed in order to evaluate clinical relevance of AR in patients undergoing CABG.

Item Type: Article
MeSH: Aged ; Aspirin / administration & dosage ; Aspirin / adverse effects ; Clopidogrel ; Coronary Artery Bypass ; Drug Resistance / drug effects ; Female ; Humans ; Male ; Middle Aged ; Platelet Aggregation Inhibitors / administration & dosage ; Platelet Aggregation Inhibitors / adverse effects ; Postoperative Care / methods ; Ticlopidine / administration & dosage ; Ticlopidine / adverse effects ; Ticlopidine / analogs & derivatives
Departments: Katedra za internu medicinu
Katedra za kirurgiju
Depositing User: Marijan Šember
Status: Published
Petričević, MateUNSPECIFIED
Kopjar, TomislavUNSPECIFIED
Gašparović, HrvojeUNSPECIFIED
Svetina, LucijaUNSPECIFIED
Zrno Mihaljević, MartinaUNSPECIFIED
Date: May 2015
Date Deposited: 04 Feb 2016 12:05
Last Modified: 23 Jul 2020 09:10
Subjects: /
Related URLs:

Actions (login required)

View Item View Item


Downloads per month over past year