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Review
. 2021 May 26;10(11):2317.
doi: 10.3390/jcm10112317.

Pleiotropic Effects of Acetylsalicylic Acid after Coronary Artery Bypass Grafting-Beyond Platelet Inhibition

Dominika Siwik  1 , Magdalena Gajewska  1 , Katarzyna Karoń  1 , Kinga Pluta  1 , Mateusz Wondołkowski  2 , Radosław Wilimski  2 , Łukasz Szarpak  3   4 , Krzysztof J Filipiak  1 , Aleksandra Gąsecka  1
Affiliations
Review

Pleiotropic Effects of Acetylsalicylic Acid after Coronary Artery Bypass Grafting-Beyond Platelet Inhibition

Dominika Siwik et al. J Clin Med. .

Abstract

Acetylsalicylic acid (ASA) is one of the most frequently used medications worldwide. Yet, the main indications for ASA are the atherosclerosis-based cardiovascular diseases, including coronary artery disease (CAD). Despite the increasing number of percutaneous procedures to treat CAD, coronary artery bypass grafting (CABG) remains the treatment of choice in patients with multivessel CAD and intermediate or high anatomical lesion complexity. Taking into account that CABG is a potent activator of inflammation, ASA is an important part in the postoperative therapy, not only due to ASA antiplatelet action, but also as an anti-inflammatory agent. Additional benefits of ASA after CABG include anticancerogenic, hypotensive, antiproliferative, anti-osteoporotic, and neuroprotective effects, which are especially important in patients after CABG, prone to hypertension, graft occlusion, atherosclerosis progression, and cognitive impairment. Here, we discuss the pleiotropic effects of ASA after CABG and provide insights into the mechanisms underlying the benefits of treatment with ASA, beyond platelet inhibition. Since some of ASA pleiotropic effects seem to increase the risk of bleeding, it could be considered a starting point to investigate whether the increase of the intensity of the treatment with ASA after CABG is beneficial for the CABG group of patients.

Keywords: ASA; Alzheimer’s disease; CABG; acetylsalicylic acid; atherosclerosis; cancer; coronary artery bypass grafting; hypertension; inflammation; osteoporosis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Possible targets for pleiotropic effects of acetylsalicylic acid in patients after coronary artery bypass grafting Figure created with BioRender.com.
Figure 2
Figure 2
Pleiotropic effects of acetylsalicylic acid (ASA) discussed in this review. For details regarding the mechanisms, please see the main text. BDNF—brain-derived neurotrophic factor; COX—cyclooxygenase; EGFR—epidermal growth factor receptor; EV—extracellular vesicles; NF-κB—nuclear factor kappa-light-chain-enhancer of activated B cells; NO—nitric oxide; PDGF—platelet-derived growth factor; PGE-2—prostaglandin E-2; PPARγ—peroxisome proliferator-activated receptor gamma; Pyk-2—proline-rich tyrosine kinase 2; TGF-β1- transforming growth factor β1. Figure created with BioRender.com.
Figure 3
Figure 3
Postoperative complications after CABG with different treatment regimens. CV deaths—cardiovascular deaths; MI—myocardial infarction.
See this image and copyright information in PMC

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