Role of Dipyrone in the High On-Treatment Platelet Reactivity amongst Acetylsalicylic Acid-Treated Patients Undergoing Peripheral Artery Revascularisation

• Published in: Medical principles and practice Vol. 27; no. 4; pp. 356 - 361
• Main Authors: Hartinger, Jan, Novotny, Robert, Bilkova, Jana, Kvasnicka, Tomas, Mitas, Petr, Sima, Martin, Hlubocky, Jaroslav, Kvasnicka, Jan, Slanar, Ondrej, Lindner, Jaroslav
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01.01.2018
• Subjects: Acids; Acute coronary syndromes; Adenosine diphosphate; Aged; Aged, 80 and over; Analgesics; Angioplasty; Anti-Inflammatory Agents, Non-Steroidal - pharmacology; Aspirin; Aspirin - adverse effects; Blood platelets; Blood Platelets - drug effects; Cardiovascular disease; Catheterization, Peripheral; Coronary Artery Disease - blood; Coronary vessels; Dipyrone - pharmacology; Drug Interactions; Female; Heart surgery; Humans; Male; Middle Aged; Mortality; Original Paper; Patients; Percutaneous Coronary Intervention; Platelet Aggregation - drug effects; Platelet Aggregation Inhibitors - pharmacology; Regression Analysis; United States > US; Germany; Peripheral arterial disease; Dipyrone; Vascular surgery; High on-treatment platelet reactivity
• ISSN: 1011-7571; 1423-0151; 1423-0151
• DOI: 10.1159/000489970

Objective: To evaluate the effects of dipyrone on sensitivity to aspirin (acetylsalicylic acid [ASA]) in patients who underwent peripheral artery vascular reconstruction. Subjects and Methods: Impedance aggregometry and light transmission aggregometry were used to determine the effects of dipyrone on ASA treatment in 21 patients. Blood samples were drawn in a 7-day period after the surgery. The cut-off value for high on-treatment platelet reactivity (HTPR) was set at < 65% of aggregation inhibition for impedance aggregometry. For light transmission aggregometry the cut-off value for arachidonic acid-induced aggregation was set at > 20% of aggregating platelets, and the cut-off value for epinephrine-induced aggregation was > 44% of aggregating platelets. The cut-off value for each method was derived from a large number of patients treated with a daily dose of 100 mg of ASA. Results: We found HTPR in 14 (67%) of the 21 patients. None had primary resistance to ASA, i.e., after the addition of ASA in vitro all samples showed antiplatelet efficacy. Regression analysis showed a possible correlation between lower efficacy of ASA treatment and higher daily doses of dipyrone (p = 0.005 for impedance aggregometry, p = 0.04 for light transmission aggregometry), higher platelet count (p = 0.005 for impedance aggregometry), and shorter time from surgery (p = 0.03 for impedance aggregometry). Conclusion: HTPR occurs in 67% of ASA-treated patients after lower limb vascular surgery. The occurrence of HTPR correlates with the daily dose of dipyrone. Therefore, dipyrone should not be used as a postoperative analgesic in ASA-treated patients after peripheral artery revascularisation due to its influence on the effectiveness of ASA.