Chemiluminescent activity and platelet aggregation in chronic coronary heart disease on acetylsalicylic acid therapy before and after coronary bypass surgery

Abstract

Introduction. Some patients after coronary artery bypass grafting (CABG) may be resistant to acetylsalicylic acid (ASA) used as an antiplatelet agent. The mechanisms of this condition are still under discussion. We studied the functional activity of ASA-resistant and -sensitive platelets using a chemiluminescent (CL) analysis. Methods. 104 patients with chronic coronary disease (CCD) were evaluated. The control group consisted of 30 healthy donors. Blood sampling was performed prior to CABG and at one and 8-10 days after CABG. Platelet aggregation with collagen, adrenaline, and ADP and platelet resistance to ASA were determined by optical aggregometry with arachidonic acid at a level ≥20%. Spontaneous and ADP-induced CL of platelets with luminol and lucigenin was studied with a biochemiluminescence analyzer. Results. 71 patients with CCD were found to be sensitive to ASA (sASA) whereas 33 patients were resistant to ASA (rASA). Most of CL indexes were higher in sASA patients than in the control group during the entire observation period; in rASA patients, values of these indexes were at the control level. Pre-CABG values of CL indexes were higher in rASA patients than in sASA patients. Lucigenin-enhanced CL was decreased in rASA patients on the first day after CABG and increased on days 8-10 compared to the preoperative level. CL indexes positively correlated with platelet aggregation in rASA patients. Conclusion. The CL method allows assessing the functional activity of platelets in CCD. The study of CL indexes may identify rASC patients before the CABG surgery. The dynamics of CL index values in sASK patients before and after surgery and the absence of such dynamics in patients with rASC suggests that aspirin resistance depends not only on the internal condition of platelets but also on intercellular relations.