Ho, K.M.

Nicola, H.

English

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  RESEARCH REPOSITORY  This is the author’s final version of the work, as accepted for publication  following peer review but without the publisher’s layout or pagination.  The definitive version is available at:   https://doi.org/10.1016/j.athoracsur.2019.08.105   Nicola, H. and Ho, K.M. (2019) Aspirin resistance significantly influences clinical and economic burden in cardiac surgery patients (Reply). The Annals of Thoracic Surgery   https://researchrepository.murdoch.edu.au/id/eprint/51743     Copyright: © 2019 The Society of Thoracic Surgeons It is posted here for your personal use. No further distribution is permitted.   Journal Pre-proofAspirin Resistance Significantly Influences Clinical and Economic Burden In CardiacSurgery Patients (Reply)Henrique Nicola, MD, Kwok Ming Ho, PhDPII: S0003-4975(19)31555-3DOI: https://doi.org/10.1016/j.athoracsur.2019.08.105Reference: ATS 33133To appear in: The Annals of Thoracic SurgeryReceived Date: 26 August 2019Accepted Date: 29 August 2019Please cite this article as: Nicola H, Ho KM, Aspirin Resistance Significantly Influences Clinical andEconomic Burden In Cardiac Surgery Patients (Reply), The Annals of Thoracic Surgery (2019), doi:https://doi.org/10.1016/j.athoracsur.2019.08.105.This is a PDF file of an article that has undergone enhancements after acceptance, such as the additionof a cover page and metadata, and formatting for readability, but it is not yet the definitive version ofrecord. This version will undergo additional copyediting, typesetting and review before it is publishedin its final form, but we are providing this version to give early visibility of the article. Please note that,during the production process, errors may be discovered which could affect the content, and all legaldisclaimers that apply to the journal pertain.© 2019 by The Society of Thoracic SurgeonsAspirin Resistance Significantly Influences Clinical and Economic Burden In Cardiac Surgery Patients (Reply) Reply To the Editor:  We thank Petricevic et al. (1) for their interest in our work (2) and their pertinent questions. Firstly, how to define aspirin resistance is contentious and to the best of our knowledge, there is still no consensus on which platelet function test is the best, let alone what cut point for each platelet function test is considered most appropriate in correlation to meaningful clinical outcomes. The cut-off − 79 AUC units – for the aspirin channel in our study was chosen based on the lower end of the normal reference range supplied by company servicing the Multiplate platelet function test in Australia. It is also important to note that the normal range varies dependent on type of anticoagulant is used in the specimen collection tube (e.g. lithium heparin vs citrate vs hirudin)(https://www.haemoview.com.au/the-instrument.html). Obviously, the lower the threshold we use to define aspirin resistance, the higher the incidence it will be within any cohort of patients.   Secondly, we agree that serial monitoring of perioperative platelet function is ideal and can potentially much more informative. This is, however, resource-demanding and may not be cost-effective especially if this is done routinely for all cardiac surgical patients. Thirdly, we did have data on surgical drain output up to 24 hours for our patients and also until drain removal. Clinicians in our study center tend to remove surgical drains before 24 hours after cardiac surgery and as such, using this time point may induce a degree of unmeasurable inconsistency between patients. The correlation of between aspirin effect and bleeding - defined by the total drain output before drain removal remained statistically significant, which corroborates the findings reported by your previous study.   Finally, use of objective individualized parameters to guide perioperative antiplatelet drug management and bleeding risk is important, and likely to be the holy grail of patient blood management. We very much look forward to reading studies validating this novel bleeding risk calculator.     Henrique Nicola, MD Kwok Ming Ho, PhD  Royal Perth and Mount Hospitals Murdoch University 197 Wellington St Perth, WA 6100, Australia Email: hnicola@me.com     References:  1. Petricevic M, Petricevic M, Biocina B. Aspirin Resistance Significantly Influences Clinical and Economic Burden In Cardiac Surgery Patients. Ann Thorac Surg 2019; in press. 2. Nicola H, Ho KM. Aspirin Resistance Incidence and Associations Between Aspirin Effect and Outcomes in Cardiac Surgery. Ann Thorac Surg 2019; in press. 

Aspirin resistance significantly influences clinical and economic burden in cardiac surgery patients (Reply)

https://researchrepository.murdoch.edu.au/id/eprint/51743/1/asprin%20resistance.pdf

Aspirin resistance significantly influences clinical and economic burden in cardiac surgery patients (Reply)

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