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Aspirin resistance in infants with shunt-dependent congenital heart disease

Published online by Cambridge University Press:  26 July 2021

Wonshill Koh Open the ORCID record for Wonshill Koh [Opens in a new window] ,
Megan Rodts Open the ORCID record for Megan Rodts [Opens in a new window] ,
Ashley Nebbia ,
Jaclyn Sawyer ,
Brandon Henry  and
David S. Cooper
Wonshill Koh*
Affiliation:
The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
Megan Rodts
Affiliation:
The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Ashley Nebbia
Affiliation:
Division of Pharmacy, The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Jaclyn Sawyer
Affiliation:
Division of Pharmacy, The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Brandon Henry
Affiliation:
The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
David S. Cooper
Affiliation:
The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
*
Author for correspondence: Wonshill Koh, MD, PhD, The Heart Institute, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 2003, Cincinnati, OH45229, USA. Tel: 513 803 5541; Fax: 513-636-3952. E-mail: Wonshill.Koh@cchmc.org
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Abstract

Introduction:

Patients with cyanotic heart disease are at an increased risk of developing thrombosis. Aspirin has been the mainstay of prophylactic anticoagulation for shunt-dependent patients with several reports of prevalent aspirin resistance, especially in neonates. We investigate the incidence of aspirin resistance and its relationship to thrombotic events and mortality in a cohort of infants with shunt-dependent physiology.

Methods:

Aspirin resistance was assessed using the VerifyNow™ test on infants with single-ventricle physiology following shunt-dependent palliation operations. In-hospital thrombotic events and mortality data were collected. Statistical analysis was performed to evaluate the effect of aspirin resistance on in-hospital thrombotic events and mortality risk.

Results:

Forty-nine patients were included with 41 of these patients being neonates. Six patients (12%) were aspirin resistant. A birth weight < 2500 grams was a significant factor associated with aspirin resistance (p = 0.04). Following a dose increase or additional dose administration, all patients with initial aspirin resistance had a normal aspirin response. There was no statistically significant difference between aspirin resistance and non-resistance groups with respect to thrombotic events. However, a statistically significant incidence of in-hospital mortality in the presence of thrombotic events was observed amongst aspirin-resistant patients (p = 0.04) in this study.

Conclusion:

Low birth weight was associated with a higher incidence of aspirin resistance. Inadequate initial dosing appears to be the primary reason for aspirin resistance. The presence of both thrombotic events and aspirin resistance was associated with significantly higher in-hospital mortality indicating that these patients warrant closer monitoring.

Keywords

Thrombosiscongenital heart diseaseshunt dependentaspirin resistance
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 5 , May 2022 , pp. 705 - 710
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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