Platelet p1A2 polymorphism enhances risk of neurocognitive decline after cardiopulmonary bypass

Joseph P. Mathew, Christine S. Rinder, J. Greg Howe, Manuel Fontes, Jill Crouch, Mark F. Newman, Barbara Phillips-Bute, Brian R. Smith

Research output: Contribution to journalArticlepeer-review

59 Scopus citations

Abstract

Background. Neurocognitive decline, often produced by atherosclerotic plaque embolization, remains a frequent complication of cardiopulmonary bypass. Plaque fragments may initiate local thrombosis, which, in turn, aggravates the embolic insult. Prothrombotic genetic factors may exacerbate this process. We investigated whether the P1A2 polymorphism of platelet GPIIIa, a prothrombotic risk factor in other cardiovascular settings, is associated with early neurocognitive decline after cardiopulmonary bypass. Methods. Neurocognitive changes were evaluated by the Mini-Mental State Examination administered preoperatively and on postoperative day 4 and the P1A geno-type determined in 70 patients undergoing cardiopulmonary bypass. Results. Forty-nine patients were P1A1/A1, and 21 were P1A1/A2 or P1A2/A2. Fifty-two patients (74%) demonstrated post-cardiopulmonary bypass neurocognitive decline, of which 34 were P1A1/A1 and 18 were P1A1/A2 or p1A2/A2. Multivariate analysis revealed that the P1A2 genotype and baseline Mini-Mental State Examination were significantly associated with greater neurocognitive decline (decreased Mini-Mental State Examination scores, p = 0.036 and 0.024, respectively). Conclusions. This study demonstrates a link between the P1A2 allele of platelet GPIIIa and more severe neurocognitive decline after cardiopulmonary bypass. Although the mechanism is unknown, it could represent exacerbation of platelet-dependent thrombotic processes associated with plaque embolism.

Original languageEnglish
Pages (from-to)663-666
Number of pages4
JournalAnnals of Thoracic Surgery
Volume71
Issue number2
DOIs
StatePublished - 2001

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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