The Association between Glycosylated Hemoglobin Level and Platelets Reactivity in Patients with Diabetes Mellitus Undergoing Elective Coronary Artery Bypass Grafting.
| Autor: | Mihaljevic MZ; Department of Cardiovascular Diseases, University Hospital Centre Zagreb, University of Zagreb, Zagreb, Croatia., Petricevic M; Department of Cardiac Surgery, University Department of Health Studies, University of Split, UHC Zagreb, Split, Croatia., Konosic S; Department of Anesthesiology, University Clinical Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia., Svetina L; Department of Cardiac Surgery, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia., Urlic M; Department of Cardiovascular Diseases, University Hospital Centre Zagreb, University of Zagreb, Zagreb, Croatia., Starcevic Z; Department of Cardiovascular Diseases, University Hospital Centre Zagreb, University of Zagreb, Zagreb, Croatia., Krzelj K; Department of Cardiac Surgery, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia., Milosevic M; Andrija Stampar Teaching Institute of Public Health, Zagreb, Croatia., Kalamar V; Department of Thoracic Surgery, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia., Gasparovic H; Department of Cardiac Surgery, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia., Biocina B; Department of Cardiac Surgery, University Clinical Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia. |
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| Jazyk: | angličtina |
| Zdroj: | The Thoracic and cardiovascular surgeon [Thorac Cardiovasc Surg] 2023 Sep; Vol. 71 (6), pp. 469-482. Date of Electronic Publication: 2022 Jun 25. |
| DOI: | 10.1055/s-0042-1748768 |
| Abstrakt: | Background: Diabetic patients tend to have increased platelet reactivity after coronary artery bypass grafting (CABG). The aim of this study was to determine the association between hemoglobin A1c (HbA1c) values and platelet reactivity and to evaluate the consequent impact on clinical outcomes in patients undergoing CABG. Methods: This prospective observational trial consecutively enrolled 225 diabetic patients undergoing CABG, between February 2014 and October 2018. HbA1c levels and platelet function (multiple electrode aggregometry [MEA]) were analyzed the day before surgery and on postoperative day 4 (POD 4). Patients were divided into two groups according to the HbA1c value: HBA1c < 7% and HbA1c ≥ 7%. Results: Significantly higher postoperative ASPI (platelet function test based on arachidonic acid) and ADP (platelet function test based on adenosine diphosphate) test values were observed at POD 4 compared with preoperative values (ASPI test: p < 0.001; ADP test: p < 0.001). The prevalence of preoperative aspirin resistance (AR) was 46.4% relative to 57.2% after surgery showing consistent increase in postoperative AR by approximately 10%. In addition, the prevalence of AR in the HbA1c < 7% group was higher by 10% compared with the HbA1c ≥ 7% group, both before and after surgery. We did not demonstrate differences in clinical outcomes between the HbA1c groups. Conclusion: Perioperative assessment of platelet reactivity in diabetic patients detects those with AR who may be at increased risk of adverse ischemic events. A personalized approach guided by MEA and administration of early and more potent antiaggregation therapy after CABG can be beneficial in this group of patients. Competing Interests: None declared. (Thieme. All rights reserved.) |
| Databáze: | MEDLINE |
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