Anti-platelet effect of aspirin is substantially reduced after administration of heparin during carotid endarterectomy Sally E. Webster, MB, BS, David.

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Anti-platelet effect of aspirin is substantially reduced after administration of heparin during carotid endarterectomy Sally E. Webster, MB, BS, David A. Payne, FRCS, Chris I. Jones, MSc, Paul D. Hayes, MD, Peter R.F. Bell, MD, Alison H. Goodall, PhD, A.Ross Naylor, MD Journal of Vascular Surgery Volume 40, Issue 3, Pages 463-468 (September 2004) DOI: 10.1016/j.jvs.2004.06.022 Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 1 Platelet aggregation in response to arachidonic acid (5 mmol/L) in patients undergoing carotid endarterectomy at time points A, pre-operative, at admission to hospital; B, After induction of anesthesia but before skin incision; C, after skin incision and soft tissue dissection but before heparinization; D, 3 minutes after heparin was administered, before insertion of shunt; E, 3 minutes after shunt opening; F, at the end of surgery, after flow restoration; G, 4 hours postoperatively; and H, 24 hours postoperatively but before the next dose of aspirin. Journal of Vascular Surgery 2004 40, 463-468DOI: (10.1016/j.jvs.2004.06.022) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 2 Platelet aggregation in 41 patients undergoing carotid endarterectomy. a, Response to arachidonic acid (5 mmol/L, solid squares; 2.5 mmol/L, solid circles), and spontaneous platelet aggregation (open circles). b, Response to adenosine diphosphate (0.1 μmol/L, solid squares), thrombin-receptor activating peptide (0.3 μmol/L, solid circles), and spontaneous platelet aggregation (open circles). Samples were analyzed at the following time points: A, preoperative, at admission to hospital; B, after induction of anesthesia but before skin incision; C, after skin incision and soft tissue dissection but before heparinization; D, 3 minutes after heparin was administered, before insertion of shunt; E, 3 minutes after shunt opening; F, at the end of surgery, after flow restoration; G, 4 hours postoperatively; and H, 24 hours postoperatively but before next dose of aspirin. Data represent mean ± SEM. Journal of Vascular Surgery 2004 40, 463-468DOI: (10.1016/j.jvs.2004.06.022) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 3 Aggregation to arachidonic acid (5 mmol/L) in 18 patients undergoing angioplasty at the following time points: A, pre-procedure, at admission to hospital; B, after angiography but before heparinization; C, 3 minutes after administration of heparin; D, after angioplasty; and E, 4 hours post procedure. Aggregation in response to 5 mmol/L of arachidonic acid (closed squares), 2.5 mmol/L of arachidonic acid (closed circles), and spontaneous platelet aggregation (open circles). Data represent mean ± SEM. Journal of Vascular Surgery 2004 40, 463-468DOI: (10.1016/j.jvs.2004.06.022) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions