Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-10T06:09:03.486Z Has data issue: false hasContentIssue false
  • English
  • Français

Prevalence of aspirin resistance by thromboelastography plus platelet mapping in children with CHD: a single-centre experience

Published online by Cambridge University Press:  03 December 2018

Fernando M. Berganza ,
Cesar Gonzalez de Alba ,
Alexander C. Egbe ,
Sergio Bartakian  and
John Brownlee
Fernando M. Berganza
Affiliation:
Department of General Pediatrics, Driscoll Children’s Hospital, Corpus Christi, TX, USA
Cesar Gonzalez de Alba
Affiliation:
Department of General Pediatrics, Driscoll Children’s Hospital, Corpus Christi, TX, USA
Alexander C. Egbe
Affiliation:
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
Sergio Bartakian
Affiliation:
Health Science Center, University of Texas, San Antonio, TX, USA
John Brownlee*
Affiliation:
Department of Pediatric Cardiology, Driscoll Children’s Hospital, Corpus Christi, TX, USA
*
Author for correspondence: J. Brownlee, MD, FAAP, FACC, Heart Center, Driscoll Children’s Hospital, 3533 S Alameda St, Corpus Christi, TX 78411, USA. Tel: 361 694 5086; Fax: 361 855 9518; E-mail: John.Brownlee@dchstx.org
Get access Rights & Permissions [Opens in a new window]

Abstract

Rationale

Aspirin resistance has been reported in up to 80% of children with cardiovascular defects undergoing surgery. Because of a patient who had embolic stroke while on therapeutic aspirin dose but in whom aspirin resistance was present on his thromboelastography platelet mapping, we chose to obtain thromboelastography platelet mapping on cardiac patients on aspirin to assess their risk.

Objectives

This study evaluates aspirin resistance noted in these patients and their characteristics.

Methods and results

This is a retrospective study of 25 patients taking aspirin for a month at therapeutic dose. In total, 11 female patients were enrolled. Ages in all subjects were 5 months to 27 years. A total of 19 patients had a Fontan surgery. Three had a cavopulomanary anastomosis, one had a hybrid procedure, and two had coronary anomalies. Compliance was assessed at the time of the clinic visit. Aspirin resistance was defined as platelet inhibition below 50%. Variables evaluated were level of platelet inhibition, age, body mass index, and gender.

Keywords

Aspirin resistancethromboelastographyplatelet mappingCHDgeneral cardiology
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 1 , January 2019 , pp. 24 - 29
Copyright
© Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Cite this article: Berganza FM, Gonzalez de Alba C, Egbe AC, Bartakian S, Brownlee J. (2018) Prevalence of aspirin resistance by thromboelastography plus platelet mapping in children with CHD: a single-centre experience. Cardiology in the Young29: 24–29. doi: 10.1017/S1047951118000021

References

1. Lisa, CH, Scott, WA, Zellers, TM, et al. Aspirin resistance in children with heart disease at risk for thromboembolism: prevalence and possible mechanisms. Pediatr Cardiol 2008; 29: 285–291.Google Scholar
2. Yee, DL, Dinu, BR, Sun, CW, et al. Low prevalence and assay discordance of “aspirin resistance” in children. Pediatr Blood Cancer 2008; 51: 86–89.Google Scholar
3. Mir, A, Frank, S, Journeycake, J, et al. Aspirin resistance in single-ventricle physiology: aspirin prophylaxis is not adequate to inhibit platelets in the immediate postoperative period. Ann Thorac Surg 2015; 99: 2158–2164.Google Scholar
4. Adatia, MRCP, Barrow, SE, Stratton, PD, Miall-Allen, VM, Ritter, JM, Haworth, SG. Thromoboxane A2 and prostacyclin biosynthesis in children and adolescents with pulmonary vascular disease. Circulation 1993; 88: 2117–2122.Google Scholar
5. Lordkipanidzé, M, Pharand, C, Schampaert, E, Turgeon, J, Palisaitis, DA, Diodati, JG. A comparison of six major platelet function tests to determine the prevalence of aspirin resistance in patients with stable coronary artery disease. Eur Heart J 2010; 28: 1702–1708.Google Scholar
6. Cattaneo, M. The clinical relevance of response variability to antiplatelet therapy. Hematology Am Soc Hematol Educ Program 2011; 2011: 70–75.Google Scholar
7. Gasparyan, AY, Watson, T, Lip, GY. The role of aspirin in cardiovascular prevention: implications of aspirin resistance. J Am Col Cardiol 2008; 51: 1829–1843.Google Scholar
8. Eikelboom, JW, Hankey, GJ, Thom, J, et al. Incomplete inhibition of thromboxane biosynthesis by acetylsalicylic acid; determinants and effect on cardiovascular risk. Circulation 2008; 118: 1705–1712.Google Scholar
9. Schmugge, M, Speer, O, Kroiss, S, et al. Monitoring aspirin therapy in children after interventional cardiac catheterization: laboratory measures, dose response, and clinical outcome. Eur J Pediatr 2015; 174: 933–941.Google Scholar
10. Tran, HA, Anand, SS, Hankey, GJ, Eikelboom, JW. Aspirin resistance. Thromb Res 2007; 120: 337–346.Google Scholar
11. Emani, S, Trainor, B, Zurakowski, D, Bair, C, Fynn-Thompson, F, Pigula, FA, Emani, A. Aspirin unresponsiveness predicts thrombosis in high-risk pediatric patients after cardiac surgery. J Thorac Cardiovasc Surg 2014; 148: 810–814; discussion 814–16.Google Scholar
12. Long, E, Pitfield, AF, Kissoon, N. Anticoagulation therapy; indications, monitoring and complication. Pediatr Emerg Care 2011; 27: 55–61; quiz 62–64.Google Scholar
13. Monagle, P, Chan, AK, Goldenberg, NA, et al. Antithrombotic therapy in neonates and children: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physician Evidence-Based Clinical Practice Guidelines. Arch Dis Child 2004; 89: 1168–1173.Google Scholar
14. Thon, KE, Hanslik, A, Male, C. Anticoagulation in children undergoing cardiac surgery. Semin Thromb Hemost 2011; 37: 826–833.Google Scholar
15. Nalyaka, S, Radhakrishnan, A, Englyst, N, Weir, N, Curzen, N. Aspirin resistance in ischemic stroke: insights using short thrombelastography. J Stroke Cerebrovasc Dis 2013; 22: 1412–1419.Google Scholar
16. Kroll, M. Thromboelastography: theory and practice in measuring hemostasis. Clin Lab News 2010; 36: 8–10.Google Scholar
17. Swallow, RA, Agarwala, RA, Dawkins, KD, et al. Thromboelastography: potential bedside tool to assess the effects of antiplatelet therapy? Platelets 2006; 17: 385–392.Google Scholar
18. Hobson, AR, Petley, GW, Dawkins, KD, Curzen, N. A novel fifteen minute test for the assessment of individual time-dependent clotting response to aspirin and clopidogrel using modified thromboelastography. Platelets 2007; 18: 497–505.Google Scholar
19. Idorn, L, Jensen, AS, Juul, K, Reimers, JI, et al. Thromboembolic complications in Fontan patients: population-based prevalence and exploration of the etiology. Pediatr Cardiol 2013; 34: 262–272.Google Scholar
20. Wessel, DL, Berger, F, Li, JS, et al. Clopidogrel in infants with systemic-to-pulmonary-artery shunts. N Engl J Med 2013; 368: 2377–2384.Google Scholar
21. Iyengar, AJ, Winlaw, DS, Galati, JC, et al. No difference between aspirin and warfarin after extracardiac Fontan in a propensity score analysis of 475 patients. Eur J Cardiothorac Surg 2016; 50: 980–987.Google Scholar
22. Schneider, GS, Rockman, CB, Berger, JS. Platelet activation increases in patients undergoing vascular surgery. Thromb Res 2014; 134: 925–926.Google Scholar
23. Romlin, BS, Wahlander, H, Stromvall-Larsson, E, Synnergen, M, Baghaei, F, Jeppson, A. Monitoring of acetyl salicylic acid-induced platelet inhibition with impedance aggregometry in children with systemic-to-pulmonary shunts. Cardiol Young 2013; 23: 225–232.Google Scholar
24. Szczeklik, W, Stodolkiewicz, E, Rzeszutko, M, Tomala, M, Chrustowicz Am Zmudka, K, Sanak, M. Urinary 11-dehydro-thromboxane B2 as a predictor of acute myocardial infarction outcomes: results of Leukotrienes and Thromboxane in Myocardial Infarction (LTIMI) study. J Am Heart Assoc 2016; 5: e003702.Google Scholar
25. Saini, A, Hartman, ME, Gage, BF, et al. Incidence of platelet dysfunction by thromboelastography-platelet mapping in children supported with ECMO: a pilot retrospective study. Front Pediatr 2016; 3: 1–8.Google Scholar
26. Nelles, NJ, Chandler, WL. Platelet mapping assay interference due to platelet activation in heparinized samples. Am J Clin Pathol 2014; 142: 331–338.Google Scholar
27. Lison, S, Weiss, G, Spannagl, M, Heindl, B. Postoperative changes in procoagulant factors after major surgery. Blood Coagul Fibrinolysis 2011; 22: 190–196.Google Scholar
28. Odendard, KC, McGowan, FX, Zurakowski, D, et al. Procoagulant and anticoagulant factor abnormalities following the Fontan procedure: increased factor VIII may predispose to thrombosis. J Thorac Cardiovasc Surg 2003; 125: 1260–1267.Google Scholar
29. Tomkiewicz-Pajak, L, Hoffman, P, Trojnarska, O, Lipcznska, M, Podolec, P, Undas, A. Abnormalities in blood coagulation, fibrinolysis, and platelet activation in adult patients after the Fontan procedure. J Thorac Cardiovasc Surg 2014; 147: 1284–1289.Google Scholar
30. Yip, C, Linden, M, Attard, C, Monagle, P, Ignjatovic, V. Platelets from children are hyper-responsive to activation by thrombin receptor activator peptide and adenosine diphosphate compared to platelets from adults. Br J Hematol 2015; 168: 526–532.Google Scholar
31. Wagener, DD, Olmsted, JB, Marder, VJ. Immunolocalization of von Willebrand protein in Weibel-Palade bodies of human endothelial cells. J Cell Biol 1982; 95: 355–360.Google Scholar