Abstract
The recommended pharmacological therapy for patients with coronary artery disease (CAD) treated by coronary artery bypass grafting (CABG) is acetylsalicylic acid (ASA). To improve the antiplatelet effect, supplementation with flavonoids is also recommended. The aim of this study was to estimate anti-aggregation properties of diosmin, in combination with ASA, pre- and postoperatively and assess the relationship of this therapy with inflammatory processes in CAD patients undergoing CABG. The study patients (n = 26) took diosmin (1000 mg/day); the control patients (n = 27) took a placebo. The therapeutic period for taking diosmin was from at least 30 days before to 30 days after CABG. All patients also took 75 mg/day ASA. Platelet aggregation and IL-6, CRP, and fibrinogen concentrations were determined before and 30 days after surgery. Results showed that diosmin did not enhance the anti-aggregation effect of ASA at any assessment time. However, there was a stronger anti-aggregation effect 30 days after surgery that was diosmin independent and was associated with acute-phase markers in the postoperative period. Increased levels of inflammatory markers in the late phase of the postoperative period may provide an unfavorable prognostic factor in long-term follow-up, which should prompt the use of stronger antiplatelet therapy in patients after CABG.
Highlights
Recommended standards of treatment for coronary artery disease (CAD) include both pharmacological and cardiosurgical treatments
Due to the high clinical significance of reduced platelet sensitivity to acetylsalicylic acid (ASA), the causes and mechanisms of reduced effectiveness of aspirin therapy are still being sought. This problem is significant in patients with coronary artery disease, especially those treated with coronary artery bypass grafting (CABG)
Statistical analyses showed a significantly large decrease in platelet aggregation in the aspirin-induced platelet inhibition (ASPI) test (p < 0.0001) and a significant increase in fibrinogen concentrations (p < 0.0001) after surgery compared to the preoperative period, both in the study group (Table 2) and in the control group (Table 3)
Summary
Recommended standards of treatment for coronary artery disease (CAD) include both pharmacological and cardiosurgical treatments. Due to the high clinical significance of reduced platelet sensitivity to ASA, the causes and mechanisms of reduced effectiveness of aspirin therapy are still being sought This problem is significant in patients with coronary artery disease, especially those treated with coronary artery bypass grafting (CABG). Some research has indicated a relationship between atrial fibrillation and increased platelet activation, possibly related to a low response to antiplatelet therapy [8,9,10]. For this and other reasons, research assessing possible improvements to the effectiveness of aspirin therapy for CABG patients still deserves the attention of cardiac surgeons. It has been shown that diosmin supplementation to ASA therapy with
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