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Monitoring aspirin therapy in children after interventional cardiac catheterization: laboratory measures, dose response, and clinical outcomes

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Abstract

Very few studies have investigated dose response of aspirin and agreement of different platelet function assays in children. One hundred five children were studied at baseline and after interventional cardiac catheterization during aspirin treatment and, in cases of aspirin resistance (AR), after dose increase. Results from arachidonate-induced aggregation (AA) were compared with aggregation induced by ADP, PFA-100 closure times (CTs), urinary 11-dehydro-thromboxane B2 (urinary 11-dhTxB2) levels, and Impact-R % surface coverage. Aspirin at 2–5 mg/kg/day inhibited platelet function in a large majority. While 19 % showed bruising and mild epistaxis, no thrombotic complications were recorded. AR was detected by AA in seven children (6.7 %). After dose increase, the majority showed inhibition by aspirin. Infants had higher urinary 11-dhTxB2 baseline levels; this assay showed some correlation with AA. Both assays manifested high sensitivity and specificity for aspirin while inferior results were found for the other assays. With the PFA-100, 15.2 % of patients were found to have AR, but this corresponded to AR by AA in only one of seven children.

Conclusion: While there was poor agreement among assays, AA and urinary 11-dhTxB2 show good specificity for the monitoring of aspirin therapy in children. Aspirin at 2–5 mg/kg inhibits platelet function; AR in children is rare and can be overcome by dose increase.

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Abbreviations

AA:

Arachidonate-induced aggregation

AR:

Aspirin resistance

ICC:

Interventional cardiac catheterization

IR:

Interquartile range

PFA-100 CT:

Platelet function analyser-100 closure time

Urinary 11-dhTxB2:

Urinary 11-dehydro-thromboxane B2

VWD:

von Willebrand disease

VWF:

von Willebrand factor

VWF:RCo:

VWF:ristocetin cofactor

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Conflict of interest

The authors declare that they do not have any conflict of interest.

Author information

Authors and Affiliations

  1. Division of Haematology and Children’s Research Centre, University Children’s Hospital, Steinwiesstrasse 75, 8032, Zurich, Switzerland

    Markus Schmugge, Oliver Speer, Sabine Kroiss & Manuela Albisetti

  2. Division of Cardiology, University Children’s Hospital, Zurich, Switzerland

    Walter Knirsch & Oliver Kretschmar

  3. Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada

    Margaret L. Rand

  4. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada

    Margaret L. Rand

Authors
  1. Markus Schmugge
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  2. Oliver Speer
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  3. Sabine Kroiss
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  4. Walter Knirsch
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  5. Oliver Kretschmar
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  6. Margaret L. Rand
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  7. Manuela Albisetti
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Correspondence to Markus Schmugge.

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Communicated by David Nadal

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Schmugge, M., Speer, O., Kroiss, S. et al. Monitoring aspirin therapy in children after interventional cardiac catheterization: laboratory measures, dose response, and clinical outcomes. Eur J Pediatr 174, 933–941 (2015). https://doi.org/10.1007/s00431-014-2485-1

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  • DOI: https://doi.org/10.1007/s00431-014-2485-1

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