Abstract 15863: Prevalence of Platelet Non-resposiveness to Aspirin by Thromboelastography (teg) in Children With Congenital Heart Disease: An Institutional Experience
Introduction: Aspirin is used to prevent thromboembolism in children with heart defects. Aspirin resistance has been reported in up to 26% of pediatric patients with cardiovascular defects undergoing surgical procedures with significant inpatient variability noted. Because of a patient who had embolic stroke while on therapeutic aspirin doses but in whom aspirin resistance was present on his thromboelastogram (TEG), we chose to obtain a TEG on cardiac patients on aspirin to assess their risk. This study evaluates aspirin resistance noted in these patients.
Hypothesis: Aspirin resistance is high in pediatric patients with heart conditions
Methods: This is a retrospective observational study with IRB approval of 21 patients taking aspirin. Seven Females and 14 males were enrolled, ages 5 months to 27 years. Fourteen had a Fontan surgery. Three had a cavo-pulomanary anastomosis, 1 had HLHS hybrid procedure, 1 had a coronary bypass due to ALCAPA and another had a coronary aneurysm. Aspirin doses were at 5 mg/kg/day but not exceeding 81 mg and had been given at least for one month. Compliance was assured with the patient/family at the time of the clinic visit. Platelet mapping with a TEG was performed on each patient. Aspirin resistance was defined as platelet inhibition below 50%. Variables evaluated were: Level of platelet inhibition(AA plt%), age in months, Weight in Kg, gender and diagnosis. Statistical
Analysis: Chi Square and Pearson Correlation.
Results: Aspirin resistance was present in 77% of these patients (50% in post Fontan and 66% in the remaining patients). There was no significant variation between genders (P 0.576) Correlation between platelet inhibition level for weight were R: -0.3233 (P 0.153) and age were R -0.0923 (P 0.69) both not significant.
Conclusions: The percentage of patients in our group on aspirin with inadequate platelet inhibition is unacceptably high and represents pharmacologic failure based on the TEG. Our findings suggest our cardiac patients may have significantly increased aspirin resistance. A larger cohort is needed to assess if traditional dosing of aspirin for antiplatelet effect is not correct for children.
Author Disclosures: F. Molina: None. S. Ghaleb: None. C. Gonzalez de Alba: None. S. Bartakian: None. J. Brownlee: None.
- © 2015 by American Heart Association, Inc.