THE PRECEDING PRO ARTICLE by van der Linden contains a wonderful review of the action
of aspirin and clopidogrel. Platelets are all important for normal hemostasis as well
as the formation of an intraluminal thrombosis from acute coronary syndrome (ACS).
Indeed, platelets are to a great degree responsible for the inflammatory and long-term
growth of atherosclerotic plaque.
1
,
2
These cells (platelets) are complex and very active. They interact with the microenvironment
of the blood vessel, shear forces, endothelium, and the surrounding tissues (tissue
factor, collagen, and thrombin).
2
,
3
Metabolic activity is maintained within them, through adenosine triphosphate consumption.
2
Platelets exhibit graded and appropriate responsiveness to a wide range of stimuli,
leading to expression of more glycoproteins, cytoskeletal contraction, shape change,
and discharge of stored messengers. They do not overreact or always fully activate
when stimulated. Clinicians (in cardiac anesthesia/surgery) tend to lump all of platelets’
many reactions into a poorly understood and widely unmonitored mystery state known
as “platelet function.” It is often said in cardiac surgery/anesthesia that the biggest
cause of bleeding in cardiac surgery is “platelet dysfunction.”
4
,
5
By day 3 to 5 after surgery, the platelets are actually more hyperactive than before
cardiac surgery.
5
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Cardiothoracic and Vascular AnesthesiaAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Linkage between inflammation and coagulation: An update on the molecular basis of crosstalk.Life Sci. 1998; 62: 1817-1824
- Spiess B.D. Spence R.K. Shander A. Platelet physiology: Cellular and protein interactions. Lippincott, Williams and Wilkins, Baltimore, MD2006: 93-102
- A revised model of platelet aggregation.J Clin Invest. 2000; 105: 783-791
- Coagulation, transfusion and cardiac surgery.in: Spiess B.D. Spence R.K. Shander A. Perioperative Transfusion Medicine. Williams and Wilkins, Baltimore, MD, Lippincott2006: 513-556
- Platelet activity before and after coronary artery bypass grafting.Platelets. 2006; 17: 289-291
- The relationship between coagulation, inflammation and endothelium: Inflammation responds.in: Spiess B.D. The Relationship Between Coagulation, Inflammation and Endothelium, SCA Monograph. Lippincott, Williams and Wilkins, Baltimore, MD2000: 91-104
- Thrombin during cardiopulmonary bypass.Ann Thorac Surg. 2006; 82: 2315-2322
- Aprotinin decreases postoperative bleeding and number of transfusions in patients on clopidogrel undergoing coronary artery bypass graft surgery: A double-blind, placebo-controlled, randomized clinical trial.Circulation. 2005; 112: I276-I280
- Functional and biochemical evaluation of platelet aspirin resistance after coronary artery bypass surgery.Circulation. 2003; 108: 542-547
- Platelet function tests predict bleeding and thrombotic events after off-pump coronary artery bypass grafting.Eur J Cardiothorac Surg. 2005; 27: 584-591
- Endothelial injury and acquired aspirin resistance as promoters of regional thrombin formation and early vein graft failure after coronary artery bypass grafting.J Thorac Cardiovasc Surg. 2006; 131: 122-130
- Individual variations in the fibrinolytic response during and after cardiopulmonary bypass.Thromb Haemost. 1995; 74: 1293-1297
- Genetic basis of procoagulant and fibrinolytic perioperative adverse events.Best Pract Res Clin Anesthesiol. 2001; 15: 195-211
- Human plasminogen activator inhibitor-I (PAI-I) deficiency: Characterization of a large kindred with a null mutation in the PAI-I gene.Blood. 1997; 90: 204-208
- Polymorphism of platelet membrane IIIa: Human platelet antigen Ib (HPA-Ib/PIA2) is an inherited risk factor for premature myocardial infarction in coronary artery disease.Thromb Haemost. 1998; 79: 731-735
- Allele-specific increase in basal transcription of the plasminogen activator inhibitor-I gene is associated with myocardial infarction.Proc Natl Acad Sci U S A. 1995; 92: 1851-1855
- Platelet function implications of glycoprotein Ib alpha polymorphisms in African Americans.Am J Hematol. 2007; 82: 15-22
- Polymorphisms in pro- and anti-inflammatory cytokine genes and susceptibility to atherosclerosis: A pathological study of 1503 consecutive autopsy cases.Hum Mol Genet. 2007; 16: 592-599
- Combination of multiple genetic risk factors is synergistically associated with carotid atherosclerosis in Japanese subjects with type 2 diabetes.Diabetes Care. 2006; 29: 2445-2451
- Genetic and acquired inflammatory conditions are synergistically associated with early carotid atherosclerosis.Stroke. 2006; 37: 2253-2259
- Thromboelastography-guided transfusion algorithm reduces transfusion in complex cardiac surgery.Anesth Analg. 1999; 88: 312-319
- Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: The PCI-CURE study.Lancet. 2001; 358: 527-533
- Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: A randomized controlled trial.JAMA. 2002; 288: 2411-2420
- Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation.N Engl J Med. 2001; 345: 494-502
- Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: Randomised placebo-controlled trial.Lancet. 2005; 366: 1607-1621
- Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation.N Engl J Med. 2005; 352: 1179-1189
- In-hospital patients exposed to clopidogrel before coronary artery bypass graft surgery: A word of caution.Ann Thorac Surg. 2005; 79: 1210-1216
- Clopidogrel and bleeding in patients undergoing elective coronary artery bypass grafting.J Thorac Cardiovasc Surg. 2004; 128: 425-431
- Clopidogrel administration prior to coronary artery bypass grafting surgery: The cardiologist’s panacea or the surgeon’s headache?.Eur Heart J. 2005; 26: 576-583
- Clopidogrel and bleeding after coronary artery bypass graft surgery.Ann Thorac Surg. 2005; 80: 928-933
- Increased blood product use among coronary artery bypass patients prescribed preoperative aspirin and clopidogrel.BMC Cardiovasc Disord. 2003; 3: 3
- Choose one: Damned if you do/Damned if you don’t!.Crit Care Med. 2005; 33: 1871-1874
- Effect of blood transfusion on long-term survival after cardiac operation.Ann Thorac Surg. 2002; 74: 1180-1186
- Role of hemodilutional anemia and transfusion during cardiopulmonary bypass in renal injury after coronary revascularization: Implications on operative outcome.Crit Care Med. 2005; 33: 1749-1756
- Persistent effect of red cell transfusion on health-related quality of life after cardiac surgery.Ann Thorac Surg. 2006; 82: 13-20
- Transfusion increases the risk of postoperative infection after cardiac surgery.J Am Coll Surg. 2006; 202: 131-138
- Transfusion of blood components and postoperative infection in patients undergoing cardiac surgery.Chest. 2001; 119: 1461-1468
- The association between duration of storage of transfused red blood cells and morbidity and mortality after reoperative cardiac surgery.Anesth Analg. 2006; 103: 15-20
- Impact of blood transfusion during cardiopulmonary bypass on operative outcomes in women undergoing coronary revascularization surgery. 2006 (10th International Congress of CV and Thoracic Anesthesia. Prague, Czech Republic, August 28,)
- Intraoperative red blood cell transfusion during coronary artery bypass graft surgery increases the risk of postoperative low-output heart failure.Circulation. 2006; 114: 43-48
- A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care.N Engl J Med. 1999; 340: 409-417
- Lowest hematocrit on bypass and adverse outcomes associated with coronary artery bypass grafting: Northern New England Cardiovascular Disease Study group.Ann Thorac Surg. 2001; 71: 769-776
- Platelet transfusions during coronary artery bypass grafting surgery are associated with serious adverse outcomes.Transfusion. 2004; 44: 1143-1148
- Aspirin and mortality from coronary bypass surgery.N Engl J Med. 2002; 34: 1309-1317
- Platelet transfusions are not associated with increased morbidity and mortality in cardiac surgery.Can J Anaesth. 2006; 53: 279-287
Article info
Identification
Copyright
© 2007 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
