Anti-platelet effect of aspirin is substantially reduced after administration of heparin during carotid endarterectomy

Journal of Vascular Surgery
S E WebsterA Ross Naylor

Abstract

Aspirin therapy is usually continued throughout the perioperative period to reduce the risk for thromboembolic stroke and myocardial infarction after carotid endarterectomy (CEA). Aspirin irreversibly binds cyclooxygenase-1, thereby reducing platelet aggregation for the lifetime of each platelet. However, recent research from this unit has shown that aggregation in response to arachidonic acid increases significantly, but transiently, during CEA, which suggests that the anti-platelet effect of aspirin is temporarily reversed. The purpose of the current study was to determine when this phenomenon occurs and to identify the possible mechanisms involved. Platelet aggregation was measured in platelet-rich plasma from 41 patients undergoing CEA who were stabilized with 150 mg of aspirin daily. Blood was taken at 8 time points: before anesthesia, after anesthesia, before heparinization, 3 minutes after heparinization, 3 minutes after shunt insertion, 10 minutes after flow restoration, 4 hours postoperatively, and 24 hours postoperatively. Platelet aggregation was also measured at similar times in a group of 18 patients undergoing peripheral angioplasty without general anesthesia. All patient platelets were effectively inhibited by as...Continue Reading

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Citations

Jun 3, 2014·Anesthesiology Clinics·J Devin Roberts, BobbieJean Sweitzer
May 6, 2011·Thrombosis and Haemostasis·Saeed H M HalawaniIsobel Ford
Sep 28, 2012·International Journal of Stroke : Official Journal of the International Stroke Society·J A KinsellaD J H McCabe
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Aug 15, 2009·Journal of Vascular Surgery·George KasotakisThomas G Lynch
Oct 8, 2014·European Journal of Internal Medicine·Inna TzoranUNKNOWN RIETE investigators
Mar 31, 2009·European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery·G S McMahonA R Naylor
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Oct 6, 2021·Clinical and Applied Thrombosis/hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis·Alia Uzra KazimiWolfgang Miesbach

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