Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Individualizing antiplatelet therapy in coronary artery disease: focus on coronary artery bypass grafting

Authors: Gvaliya S.L., Buziashvili Yu.I., Ioshina V.I., Asymbekova E.U., Tugeeva E.F., Sherstyannikova O.M., Songurov R.N., Grishenok A.V.

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2023-20-1-67-77

UDC: 616.151.55:616.12-008.46-089.86

Link: Clinical Physiology of Blood Circulaiton. 2023; 1 (20): 67-77

Quote as: Gvaliya S.L., Buziashvili Yu.I., Ioshina V.I., Asymbekova E.U., Tugeeva E.F., Sherstyannikova O.M., Songurov R.N., Grishenok A.V. Individualizing antiplatelet therapy in coronary artery disease: focus on coronary artery bypass grafting. Clinical Physiology of Circulation. 2023; 20 (1): 67–77 (in Russ.). DOI: 10.24022/1814-6910-2023-20-1-67-77

Received / Accepted:  20.01.2023 / 17.03.2023

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Abstract

Objective. To assess the feasibility, efficacy, safety and impact on the prognosis of individualization of the selection of antiplatelet therapy in patients with coronary artery disease (CAD) undergoing elective coronary artery bypass grafting (CABG) under laboratory control (monitoring of the platelet functional activity).

Material and methods. The study included 341 patients with CAD undergoing elective CABG at the Bakoulev National Medical Research Center for Cardiovascular Surgery. A comparative analysis of 2 groups of patients was carried out, comparing an individual approach to antiplatelet therapy (APT) under laboratory support (group 1 – main, prospective, n =177) and standard APT regimens (group 2 – control, retrospective, n =164). The efficacy/safety of APT was assessed by clinical outcomes depending on the achievement of target values of platelet aggregation within the boundaries of the “therapeutic window”.

Results. When using a pathogenetically substantiated DAPT strategy during the first 3 months of observation, platelet activity remained high in most patients (p < 0.001 for all analyzed aggregation parameters); at all subsequent periods of observation, the average values of aggregation indicators fit into the range of target values. A comparative analysis of the total number of negative clinical outcomes after discharge from the hospital showed advantages in the main observation group (23 (13.0%) patients versus 53 (32.3%) in the control group; p<0.001), and mainly, due to the least number of ischemic events (stenosis/thrombosis of the shunt, progression of atherosclerosis in native arteries, recurrence of angina pectoris, myocardial infarction, stroke).

Conclusion. A personalized approach to the choice of APT schemes/regimes, based on laboratory support of the functional activity of platelets, demonstrates clear advantages in clinical outcomes in this category of patients.

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****
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  28. Smith P.K., Goodnough L.T., Levy J.H., Poston R.S., Short M.A., Weerakkody G.J. et al. Mortality benefit with prasugrel in the TRITON-TIMI 38 coronary artery bypass grafting cohort: risk-adjusted retrospective data analysis. J. Am. Coll. Cardiol. 2012; 60 (5): 388–96. DOI: 10.1016/j.jacc.2012.03.030
  29. Van Poucke S., Stevens K., Wetzels R., Kicken C., Verhezen P., Theunissen M. et al. Early platelet recovery following cardiac surgery with cardiopulmonary bypass. Platelets. 2016; 27 (8): 751–7. DOI: 10.3109/09537104.2016.1173665
  30. Ivert T., Dalén M., Ander C., Stålesen R., Lordkipanidzé M., Hjemdahl P. Increased platelet reactivity and platelet-leukocyte aggregation after elective coronary bypass surgery. Platelets. 2019; 30 (8): 975–81. DOI: 10.1080/09537104.2018.1542122
  31. Tüysüz M.E., Dedemoˇglu M. High mean platelet volume to platelet count ratio as a predictor on poor outcomes after CABG. Gen. Thorac. Cardiovasc. Surg. 2020; 68 (5): 459–66. DOI: 10.1007/s11748-019-01202-7
  32. Sembi N., Cheng T., Ravindran W., Ulucay E., Ahmed A., Harky A. Anticoagulation and antiplatelet therapy post coronary artery bypass surgery. J. Card. Surg. 2021; 36 (3): 1091–9. DOI: 10.1111/jocs.15283

About Authors

  • Sofiya L. Gvaliya, Postgraduate; ORCID
  • Yuriy I. Buziashvili, Dr. Med. Sci., Professor, Academician of RAS, Head of Clinical and Diagnostic Department; ORCID
  • Viktoriya I. Ioshina, Dr. Med. Sci., Senior Researcher; ORCID
  • Elmira U. Asymbekova, Dr. Med. Sci., Leading Researcher; ORCID
  • Elvina F. Tugeeva, Dr. Med. Sci., Senior Researcher; ORCID
  • Olga M. Sherstyannikova, Cand. Med. Sci., Researcher; ORCID
  • Rashid N. Songurov, Cardiologist; ORCID
  • Alena V. Grishenok, Postgraduate; ORCID

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