[Peculiarities of hemostasis, metabolic activity of platelets, and rate of aspirin resistance in patients with chronic heart failure after aorto-coronary bypass surgery].

: Aim of the study was to investigate in dynamics peculiarities of hemostasis including platelet aggregation and activity of NADP-dependent dehydrogenases in platelets, as well as prevalence of resistance to aspirin in patients with functional class II-III chronic heart failure (CHF). We determined parameters of vascular thrombocytic and coagulative hemostasis, the state of intracellular metabolism of platelets as assessed by activity of NADP-dependent dehydrogenases in 46 men (age 45 - 72 years) with NYHA class II (n=16) and III (n=30) CHF before and in 12 - 14 days after coronary artery bypass grafting (CABG). After CABG all patients received aspirin (75 - 150 mg/day). Patients with ischemic CHF had moderate activation of intravascular coagulation, endotheliosis, elevation of fibrinogen and plasminogen levels. These processes were significantly augmented after CABG and were most pronounced in class II CHF. At the background of therapy with aspirin in 36 patients (78.3%) ADP and adrenaline induced platelet aggregation was reduced 2 - 3 times. In 10 patients (21.7%) aggregation remained at initial level or even increased what evidenced for resistance to aspirin. Among patients with functional classes II and III CHF portion of resistant to aspirin was 12.5 and 26.6%, respectively. In these patients most striking changes in intracellular metabolism of platelets were revealed. These changes manifested as derangements of energetic and plastic processes in the cell. Thus aspirin resistant patients with CHF comprise a group with risk of development of atherothrombosis of coronary arteries, arteriovenous grafts and arterial conduits.