Con: continuation of aspirin/clopidogrel for cardiac surgery.

摘要

THE PRECEDING PRO ARTICLE by van der Linden contains a wonderful review of the action of aspirin and clopidogrel. Platelets are all important for normal hemostasis as well as the formation of an intraluminal thrombosis from acute coronary syndrome (ACS). Indeed, platelets are to a great degree responsible for the inflammatory and long-term growth of atherosclerotic plaque. These cells (platelets) are complex and very active. They interact with the microenvironment of the blood vessel, shear forces, endothelium, and the surrounding tissues (tissue factor, collagen, and thrombin). Metabolic activity is maintained within them, through adenosine triphosphate consumption. Platelets exhibit graded and appropriate responsiveness to a wide range of stimuli, leading to expression of more glyco-proteins, cytoskeletal contraction, shape change, and discharge of stored messengers. They do not overreact or always folly activate when stimulated. Clinicians (in cardiac anesthesia/surgery) tend to lump all of platelets' many reactions into a poorly understood and widely unmonitored mystery state known as "platelet function." It is often said in cardiac surgery/anesthesia that the biggest cause of bleeding in cardiac surgery is "platelet dysfunction." By day 3 to 5 after surgery, the platelets are actually more hyperactive than before cardiac surgery.