C Li1, J Hirsh, C Xie, M A Johnston, J W Eikelboom. 1. Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China. lijay@njmu.edu.cn
Abstract
BACKGROUND: Guidelines recommend stopping aspirin and clopidogrel 7 to 10 days before surgery to allow time for replacement of permanently inhibited platelets by newly released uninhibited platelets. OBJECTIVES: The purpose of the present study was to determine the rate of offset of the anti-platelet effects of aspirin and clopidogrel after stopping treatment and the proportion of untreated donor platelets that are required to reverse their anti-platelet effects. METHODS: Cohort 1 consisted of 15 healthy subjects who received aspirin 81 mg day(-1) or clopidogrel 75 mg day(-1) for 7 days and underwent serial blood sampling until platelet function testing results normalized. Cohort 2 consisted of 36 healthy subjects who received aspirin 325 mg day(-1), clopidogrel 75 mg day(-1), aspirin 81 mg day(-1) plus clopidogrel 75 mg day(-1) or no treatment for 7 days and underwent a single blood sampling. RESULTS: In cohort 1, arachidonic acid (AA)-induced light transmission aggregation (LTA) returned to baseline levels in all subjects within 4 days of stopping aspirin, coinciding with the partial recovery of plasma thromboxane B(2) concentrations. ADP-induced LTA did not return to baseline levels until 10 days after stopping clopidogrel. In cohort 2, AA-induced LTA in patient treated with aspirin reached control levels after mixing with 30% untreated donor platelets whereas ADP-induced LTA in patients treated with clopidogrel reached control levels only after the addition of 90% or more donor platelets. CONCLUSIONS: Platelet aggregation recovers within 4 days of stopping aspirin but clopidogrel must be stopped for 10 days to achieve a normal aggregatory response.
BACKGROUND: Guidelines recommend stopping aspirin and clopidogrel 7 to 10 days before surgery to allow time for replacement of permanently inhibited platelets by newly released uninhibited platelets. OBJECTIVES: The purpose of the present study was to determine the rate of offset of the anti-platelet effects of aspirin and clopidogrel after stopping treatment and the proportion of untreated donor platelets that are required to reverse their anti-platelet effects. METHODS: Cohort 1 consisted of 15 healthy subjects who received aspirin 81 mg day(-1) or clopidogrel 75 mg day(-1) for 7 days and underwent serial blood sampling until platelet function testing results normalized. Cohort 2 consisted of 36 healthy subjects who received aspirin 325 mg day(-1), clopidogrel 75 mg day(-1), aspirin 81 mg day(-1) plus clopidogrel 75 mg day(-1) or no treatment for 7 days and underwent a single blood sampling. RESULTS: In cohort 1, arachidonic acid (AA)-induced light transmission aggregation (LTA) returned to baseline levels in all subjects within 4 days of stopping aspirin, coinciding with the partial recovery of plasma thromboxane B(2) concentrations. ADP-induced LTA did not return to baseline levels until 10 days after stopping clopidogrel. In cohort 2, AA-induced LTA in patient treated with aspirin reached control levels after mixing with 30% untreated donor platelets whereas ADP-induced LTA in patients treated with clopidogrel reached control levels only after the addition of 90% or more donor platelets. CONCLUSIONS: Platelet aggregation recovers within 4 days of stopping aspirin but clopidogrel must be stopped for 10 days to achieve a normal aggregatory response.
Authors: M U Zafar; C Santos-Gallego; D A Vorchheimer; J F Viles-Gonzalez; S Elmariah; C Giannarelli; S Sartori; D S Small; J A Jakubowski; V Fuster; J J Badimon Journal: J Thromb Haemost Date: 2013-01 Impact factor: 5.824