Skip to main content
SpringerLink
Log in

Niedrig dosierte Acetylsalicylsäure (100 mg/Tag) nach aortokoronarer Bypassoperation

Low — Dose acetylsalicylic acid after aortocoronary bypass surgery

  • Originalien
  • Published:
Klinische Wochenschrift Aims and scope Submit manuscript

Summary

A prospective, randomized, doubleblind, placebo-controlled trial was conducted to evaluate the efficacy of Acetylsalicylic Acid (ASS) (100 mg/d, starting 24 h after operation) on vein graft patency. Sixty of 88 patients having undergone surgery entered the study; in 24 of 31 patients in the placebo group and 22 of 29 patients in the ASS-group angiography was performed 4 months postoperatively. There were no significant differences between the groups with respect to age, number of diseased vessels or previous myocardial infarctions. Mean number of grafts per patient was 2,2 (placebo) and 1,8 (ASS) for proximal anastomoses (p<0.10) and 3.4 (placebo) and 2.6 (ASS) for distal anastomoses (p<0.05). Graft occlusion rate for proximal anastomoses was less in the ASS-group, 10% (4/40), as compared with placebo 32% (17/53) (p<0.05). Graft occlusion rate for distal anastomoses was also less in the ASS group, 19% (11/57) as compared to 35% (28/81) in the placebo group (p<0.10). All grafts were patent in 16/22 patients in the ASS group but only in 9/24 in the placebo group (p<0.05). On designation of patients without postoperative angiograms but cardiovascular events as well as those with at least one graft occluded as “failures”, the incidence of the latter was 9/29 in the ASS group and 20/31 in the placebo group (p<0.05). Early postoperative bleeding was similar in both groups, no side effects of ASS were observed. In this trial with initiation of low — dose ASS therapy 24 h after operation, antiplatlet therapy reduced the graft occlusion rate significantly.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Literatur

  1. Baenzinger NL, Becherer PR, Majerus PW (1979) Characterisation of prostacyclin synthesis in cultured human arterial smoth muscle cells, venous endothelial cells, an skin fibroblasts. Cell 16:964–974

    Google Scholar 

  2. Baur HR, Van Tassel RA, Pierchach CA, Globel PL (1982) Effect of sulfinpyrazone on early graft closure after myocardial revascularisation. Am J Cardiol 49:420–424

    Google Scholar 

  3. Burch JW, Baenzinger NL, Stanford N, Majerus PW (1978) Sensitivity of fatty acid cyclo-oxygenase from human aorta to acetylation by Aspirin. Proc Natl Acad Sci USA 75:5181–5184

    Google Scholar 

  4. Campeau L, Lesperance J, Grondin CM, Bourassa MG (1977) Angiographic evaluation of postoperative changes in saphenous vein aortocoronary bypass grafts and coronary arteries. In: YuP, Goodwin JF (Hrsg) Progress in cardiology. Lea and Febinger, Philadelphia, pp 185–211

    Google Scholar 

  5. Chesebro JH, Clements IP, Fuster V, Elveback LR, Smith HC, Bardsley WT, Frye RL, Holmes DR, Vliestra RE, Pluth JR, Wallace RB, Puga FJ, Orszulak TA, Piehler JM (1982) A platelet-inhibitor-drug trial in coronary-artery bypass operation: Benefit of perioperative dipyridamole and aspirin therapy on early postoperative vein-graft patency. N Engl J 307:73–78

    Google Scholar 

  6. Chesebro JH, Fuster V, Clements JP, Elveback LR, Smith HC, Holmes DR, Bardsely WT, Pluth JR, Wallace RB, Puga FJ, Orzulak TA, Pichler JM, Danielson GK, Schatt HV, Frye LR (1984) Effect of Dipyridamale and Aspirin on late vein-graft patency after coronary bypass operations. N Engl J 310:209–214

    Google Scholar 

  7. Der Simonian R, Charette LJ, McPeek B, Mosteller F (1982) Reportin methods in clinical trials. N Engl J Med 306:1332–1337

    Google Scholar 

  8. Fitzgerald GA, Oates JA, Hawiger J, Maas RL, Roberts II LJ, Lawson JA, Brash AR (1983) Endogenous biosynthesis of prostacyclin an thromboxane and platlet function during chronic administration of aspirin in man. J Clin Invest 71:676–688

    Google Scholar 

  9. Fitzgibbon GM, Burton JR, Leach AJ (1978) Coronary bypass graft fate. Circulation 57:1070–1075

    Google Scholar 

  10. Fuster V, Dewanjec MK, Kaye MP, Josa M, Metke MP, Chesebro JN (1979) Nonivasive radioisotopic technique for detection of platelet deposition in coronary artery bypass grafts in dogs and its reduction with platlet inhibitors. Circulation 60:1508–1512

    Google Scholar 

  11. Giffors RH, Feinstein AR (1969) a critique of methodology in studies of anticoagulant therapy for acute myocardial infarction. N Engl J Med 280:351–357

    Google Scholar 

  12. Gohlke H, Gohlke-Bärwolf C, Stürzenhofecker P, Görnandt L, Ritter B, Reichelt M, Buchwalsky R, Schmuziger M, Roskamm H (1981) Improved graft patency with anticoagulant therapy after aortocoronary bypass sugery: A prospective, randomized study. Circulation 64: Suppl II II-22–II-27

    Google Scholar 

  13. Hamby RJ, Ajntablian A, Handler M, Voletj C, Weisz D, Garvey JW, Wisoff G (1979) Aortocoronary saphenons vein bypass grafts. Circulation 60:901–908

    Google Scholar 

  14. Harter HR, Burch JW, Majerus PW, Standford N, Demez JA, Anderson CB, Weerts CA (1979) Prevention of thrombosis in patients on haemodialysis by low dose aspirin. N Engl J Med 301:577–579

    Google Scholar 

  15. Korbut R, Moncada S (1978) Prostacyclin (PGI2) and thromboxane A2, interaction in vivo. Regulation by aspirin and relationship with antithrombotic therapy. Thromb Res 13:489–500

    Google Scholar 

  16. Lewis HD, Davis JW, Archibald DG, Steinke WE, Smitherman TC, Doherty JE, Schnaper HW, LeWinter MM, Lineares E, Pouget JM, Sabharwal SC, Chesler E, DeMots H (1983) Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina. N Engl J Med 309:396–403

    Google Scholar 

  17. Lorenz R, Siess W, Weber PC (1981) Effects of very low versus standard acetylsalicyclic acid, dipyrodamole and sulfinpyrazone on platelet function and thromboxan formation for man. Europ J Pharmacol 70:511–518

    Google Scholar 

  18. Lorenz R, v. Schacky C, Meister W, Weber M, Kotzur J, Reichart B, Theisen K, Weber PC (1983) Sehr niedrig dosierte Acetylsalicylsäure nach aortokoronarer Bypassoperation, Konzept und Wirksamkeit. Vhdl Dtsch Ges Inn Med 89:1112–1113

    Google Scholar 

  19. Mayer JE, Lindsay WG, Castaneda W, Nicoloff DM (1981) Influence of aspirin and dipyridamol on patency coronary artery bypass grafts. Ann thor surg 31:204–210

    Google Scholar 

  20. McEnany MT, Salzmann EW, Mundth ED, DeSanctis RW, Harthorne JW, Weintraub RM, Gates S, Austen WG (1982) The effect of antithrombotic therapy on patency rates of saphenous vein coronary artery bypass grafts. J Thorac Cardiovasc Surg 83:81–89

    Google Scholar 

  21. Miller RG (1980) Combining 2×2 contegency tables. In: Miller RG, Bradley E, Brown BW, Moses LE (Hrsg) Biostatistics Casebox. J. Wiley, New York, pp 77–81

    Google Scholar 

  22. Moncada S, Gryglewski R, Bunting S, Vane JR (1976) An enzyme isolated from arteries transforms prostaglandin endoperoxides to an unstable substance that inhibits platelet aggregation. Nature 263:663–665

    Google Scholar 

  23. Moncada S, Vane JR (1977) The discovery of prostacyclin a fresh insight into arachidonic acid metabolism. In: Karasch N, Fried J (Hrsg) Biochemical aspects of prostaglandines and thromboxanes. Academic Press, New York, pp 155–169

    Google Scholar 

  24. O'Grady J, Moncada S (1978) Aspirin: A paradoxical effect on bleeding time. Lancet IV:760

    Google Scholar 

  25. Pantely GA, Goddnigth SH, Rahimtoola SH, Harlan BJ, Demots H, Calvin L, Rösch J (1979) Failure of antiplatelet and anticoagulant therapy to improve patency rate of grafts after coronary-artery bypass. N Engl J Med 301:962–966

    Google Scholar 

  26. Peto R, Pike MC, Armitage P, Breslow NE, Cox DR, Howard SV, Matel N, McPherson K, Peto J, Smith PG (1977) Design and analysis of randomized clinical trials which require prolonged observations of each patient. Br J Cancer 35:1–39

    Google Scholar 

  27. Rahimtoola SH (1982) Coronary bypass surgery for chronic angina — a perspective. Circulation 65:225–241

    Google Scholar 

  28. Salzmann EW (1982) Aspirin to prevent arterial thrombosis. N Engl J Med 307:113–115

    Google Scholar 

  29. Sharma GVRK, Khuri SF, Josa M, Folland ED, Parisi AF (1983) The effect of antiplatelet therapy on saphenous vein coronary artery bypass graft patency. Circulation 68 (suppl II):218–221

    Google Scholar 

  30. Stule PP, Weily SH, Danies H, Genton E (1973) Platelet function studies in coronary artery disease. Circulation 48:1194–1200

    Google Scholar 

  31. Weber M, Zitzmann A, Theisen K, Halbritter R, Angermann C, Jahrmärker H (1981) Koronar- und Ventrikelangiographie bei stabiler und instabiler Angina pectoris: Befunde vor und nach Bypassoperation. Vhdl Dtsch Ges Inn Med 87, S 483–485

    Google Scholar 

  32. Weber M, v. Schacky C, Lorenz R, Meister W, Kotzur J, Reichart B, Theisen K, Weber PC (1983) Niedrig dosierte Acetylsalicylsäure nach aortokoronarer Bypassoperation. Z Kardiol 72 (suppl 1):51

    Google Scholar 

  33. Weksler BB, Pett SB, Alonso D, Richter RC, Stelzer P, Subramanian V, Tack-Goldmann KM, Gay WA (1983) Differential inhibition by aspirin of vascular and platelet prostaglandin synthesis in artherosclerotic patients. N Engl J Med 308:800–805

    Google Scholar 

  34. Zajtchuk R, Collins CJ, Schuchmann GF, Holley PW, Hamacker WR (1978) Coagulation abnormalities in patients undergoing myocardial revascularisation. J Thorac Cardiovasc surg 75:168–170

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medizinische Klinik Innenstadt und Herzchirurgische Klinik der Ludwig-Maximilians-Universität München, Germany

    M. Weber, C. v. Schacky, R. Lorenz, W. Meister, J. Kotzur, B. Reichart, K. Theisen & P. C. Weber

Authors
  1. M. Weber
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. v. Schacky
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Lorenz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. W. Meister
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Kotzur
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. B. Reichart
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. K. Theisen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. P. C. Weber
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Teile dieser Studie wurden auf der 49. Tagung der Deutschen Gesellschaft für Herz- und Kreislaufforschung in Mannheim im April 1983 [32] und auf der 89. Tagung der Deutschen Gesellschaft für Innere Medizin, Wiesbaden, April 1983 [18] vorgetragen. Mit Unterstützung der Deutschen Forschungsgemeinschaft

Rights and permissions

Reprints and permissions

About this article

Cite this article

Weber, M., v. Schacky, C., Lorenz, R. et al. Niedrig dosierte Acetylsalicylsäure (100 mg/Tag) nach aortokoronarer Bypassoperation. Klin Wochenschr 62, 458–464 (1984). https://doi.org/10.1007/BF01726907

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01726907

Key words

Search

Navigation