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Heart, Lung and Circulation

Platelet Activity Measured by VerifyNow® Aspirin Sensitivity Test Identifies Coronary Artery Bypass Surgery Patients at Increased Risk for Postoperative Bleeding and Transfusion

  • Sophie Chatterton
    Affiliations
    Department of Cardiac Surgery and Cardiology, Liverpool Hospital, South Western Sydney LHD, Sydney, NSW, Australia

    South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
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  • Rebecca Dignan
    Correspondence
    Corresponding author at: Cardiothoracic Surgery Unit, Liverpool Hospital, Locked Bag 7103, Liverpool BC, New South Wales 1871, Australia. Tel.: +612 8738 3006; Fax +612 8738 4080.
    Affiliations
    Department of Cardiac Surgery and Cardiology, Liverpool Hospital, South Western Sydney LHD, Sydney, NSW, Australia

    South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
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  • Queenie Luu
    Affiliations
    Department of Cardiac Surgery and Cardiology, Liverpool Hospital, South Western Sydney LHD, Sydney, NSW, Australia

    South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
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  • Waleed Aty
    Affiliations
    Department of Cardiac Surgery and Cardiology, Liverpool Hospital, South Western Sydney LHD, Sydney, NSW, Australia

    Department of Cardiothoracic Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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  • Singithi Chandrasiri
    Affiliations
    Department of Cardiac Surgery and Cardiology, Liverpool Hospital, South Western Sydney LHD, Sydney, NSW, Australia

    South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
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  • John K. French
    Affiliations
    Department of Cardiac Surgery and Cardiology, Liverpool Hospital, South Western Sydney LHD, Sydney, NSW, Australia

    South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
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Published:April 13, 2019DOI:https://doi.org/10.1016/j.hlc.2019.03.016

      Background

      Identifying predictors of bleeding in patients before coronary artery bypass grafting surgery is important, given the complications of bleeding and finite supply of blood. Patient response to aspirin is heterogeneous and can be evaluated using point-of-care platelet function tests. We postulated that patients who hyper-respond to aspirin given preoperatively, as identified by VerifyNow® Aspirin assay (Accumetrics, Inc., San Diego, CA, USA), are at increased risk of bleeding and transfusion.

      Methods

      This prospective pilot study examined response to aspirin in patients undergoing coronary artery bypass grafting surgery (n = 61) from 2009 to 2013. Patients with aspirin reaction unit (ARU) values in the lower 50th percentile as identified by VerifyNow® assays were defined as aspirin hyper-responders. The proportion of patients transfused and the median adjusted indexed drop in haemoglobin were compared between aspirin hyper-responders and non-hyper-responders. Logistic regression was performed to determine factors associated with increased risk of transfusion.

      Results

      Seventy per cent (70%) of aspirin hyper-responders were transfused perioperatively compared with 39% of patients who did not hyper-respond, (OR 3.694, 95% CI 1.275–10.706, p = 0.014). VerifyNow® Aspirin hyper-responders had a greater median adjusted indexed drop in haemoglobin compared to non-hyper-responders (34.1 g/L versus 26.6 g/L respectively, p = 0.032). Multivariate analysis also showed VerifyNow® Aspirin hyper-response to be an independent predictor of transfusion (p = 0.016). Other variables such as age, gender, body mass index, renal insufficiency, and cross clamp and bypass times were not predictors of postoperative bleeding in this pilot cohort.

      Conclusions

      VerifyNow® Aspirin is able to preoperatively identify aspirin hyper-responders at an increased risk of bleeding and subsequent transfusion in the context of coronary artery bypass graft surgery.

      Keywords

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