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Hou X. Epoxidase inhibitor-aspirin resistance and the relationship with genetic polymorphisms: a review. J Int Med Res 2024; 52:3000605241230429. [PMID: 38420770 PMCID: PMC10903214 DOI: 10.1177/03000605241230429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 01/18/2024] [Indexed: 03/02/2024] Open
Abstract
Strokes are the leading cause of death in most regions of the world. Epoxidase inhibitors include the drug aspirin (acetylsalicylic acid). Aspirin is widely used as first-line treatment for the prevention of cardiovascular and cerebrovascular diseases in at-risk patients. However, patients using conventional doses of aspirin can still develop ischaemic cardiovascular and cerebrovascular diseases, a phenomenon known as aspirin resistance. The occurrence of aspirin resistance hinders the prevention and treatment of ischaemic cardiovascular and cerebrovascular diseases. There are many factors affecting aspirin resistance, such as sex, drug dose, metabolic disease, genetic polymorphisms, drug interactions and pharmacokinetics. Genetic polymorphism refers to the simultaneous and frequent presence of two or more discontinuous variants or genotypes or alleles in a population of organisms. Platelets contain a large number of highly polymorphic transmembrane glycoprotein receptors encoded by two or more isomeric alleles. Changes in gene polymorphisms in various pathways during platelet aggregation can lead to aspirin resistance. This narrative review describes the gene polymorphisms that have been demonstrated to be significantly associated with aspirin resistance. Research on the mechanisms of aspirin resistance and increased knowledge should provide accurate drug guidance in individuals that require first-line antiplatelet therapy.
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Affiliation(s)
- Xiaolin Hou
- Department of Emergency Medicine, Zigong First People’s Hospital, Zigong City, China
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2
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Alvikas J, Zenati M, Campwala I, Jansen JO, Hassoune A, Phelos H, Okonkwo DO, Neal MD. Rapid detection of platelet inhibition and dysfunction in traumatic brain injury: A prospective observational study. J Trauma Acute Care Surg 2022; 92:167-176. [PMID: 34629458 PMCID: PMC8677601 DOI: 10.1097/ta.0000000000003427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/14/2021] [Accepted: 09/22/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Rapid platelet function testing is frequently used to determine platelet function in patients with traumatic intracranial hemorrhage (tICH). Accuracy and clinical significance of decreased platelet response detected by these tests is not well understood. We sought to determine whether VerifyNow and whole blood aggregometry (WBA) can detect poor platelet response and to elucidate its clinical significance for tICH patients. METHODS We prospectively enrolled patients with isolated tICH between 2018 and 2020. Demographics, medical history, injury characteristics, and patient outcomes were recorded. Platelet function was determined by VerifyNow and WBA testing at the time of arrival to the trauma bay and 6 hours later. RESULTS A total of 221 patients were enrolled, including 111 patients on no antiplatelet medication, 78 on aspirin, 6 on clopidogrel, and 26 on aspirin and clopidogrel. In the trauma bay, 29.7% and 67.7% of patients on no antiplatelet medication had poor platelet response on VerifyNow and WBA, respectively. Among patients on aspirin, 72.2% and 82.2% had platelet dysfunction on VerifyNow and WBA. Among patients on clopidogrel, 67.9% and 88.9% had platelet dysfunction on VerifyNow and WBA. Patients with nonresponsive platelets had similar in-hospital mortality (3 [3.0%] vs. 6 [6.3%], p = 0.324), tICH progression (26 [27.1%] vs. 24 [26.1%], p = 0.877), intensive care unit admission rates (34 [34.3%] vs. 38 [40.0%), p = 0.415), and length of stay (3 [interquartile range, 2-8] vs. 3.2 [interquartile range, 2-7], p = 0.818) to those with responsive platelets. Platelet transfusion did not improve platelet response or patient outcomes. CONCLUSION Rapid platelet function testing detects a highly prevalent poor platelet response among patients with tICH, irrespective of antiplatelet medication use. VerifyNow correlated fairly with whole blood aggregometry among patients with tICH and platelet responsiveness detectable by these tests did not correlate with clinical outcomes. In addition, our results suggest that platelet transfusion may not improve clinical outcomes in patients with tICH. LEVEL OF EVIDENCE Diagnostic tests, level II.
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Polzin A, Dannenberg L, Helten C, Pöhl M, Metzen D, Mourikis P, Dücker C, Marschall U, L'Hoest H, Hennig B, Zako S, Trojovsky K, Petzold T, Jung C, Levkau B, Zeus T, Schrör K, Hohlfeld T, Kelm M. Excess Mortality in Aspirin and Dipyrone (Metamizole) Co-Medicated in Patients With Cardiovascular Disease: A Nationwide Study. J Am Heart Assoc 2021; 10:e022299. [PMID: 34726072 PMCID: PMC8751960 DOI: 10.1161/jaha.121.022299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Pain is a major issue in our aging society. Dipyrone (metamizole) is one of the most frequently used analgesics. Additionally, it has been shown to impair pharmacodynamic response to aspirin as measured by platelet function tests. However, it is not known how this laboratory effect translates to clinical outcome. Methods and Results We conducted a nationwide analysis of a health insurance database in Germany comprising 9.2 million patients. All patients with a cardiovascular event in 2014 and subsequent secondary prevention with aspirin were followed up for 36 months. Inverse probability of treatment weighting analysis was conducted to investigate the rate of mortality, myocardial infarction, and stroke/transient ischemic attack between patients on aspirin‐dipyrone co‐medication compared with aspirin‐alone medication. Permanent aspirin‐alone medication was given to 26,200 patients, and 5946 patients received aspirin–dipyrone co‐medication. In the inverse probability of treatment weighted sample, excess mortality in aspirin–dipyrone co‐medicated patients was observed (15.6% in aspirin‐only group versus 24.4% in the co‐medicated group, hazard ratio [HR], 1.66 [95% CI, 1.56–1.76], P<0.0001). Myocardial infarction and stroke/transient ischemic attack were increased as well (myocardial infarction: 1370 [5.2%] versus 355 [5.9%] in aspirin‐only and co‐medicated groups, respectively; HR, 1.18 [95% CI, 1.05–1.32]; P=0.0066, relative risk [RR], 1.14; number needed to harm, 140. Stroke/transient ischemic attack, 1901 [7.3%] versus 506 [8.5%] in aspirin‐only and co‐medicated groups, respectively; HR, 1.22 [95% CI, 1.11–1.35]; P<0.0001, RR, 1.17, number needed to harm, 82). Conclusions In this observational, nationwide analysis, aspirin and dipyrone co‐medication was associated with excess mortality. This was in part driven by ischemic events (myocardial infarction and stroke), which occurred more frequently in co‐medicated patients as well. Hence, dipyrone should be used with caution in aspirin‐treated patients for secondary prevention.
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Affiliation(s)
- Amin Polzin
- Division of Cardiology, Pulmonology, and Vascular Medicine, Cardiovascular Research Institute Düsseldorf (CARID) Heinrich Heine University Medical Center Düsseldorf Düsseldorf Germany
| | - Lisa Dannenberg
- Division of Cardiology, Pulmonology, and Vascular Medicine, Cardiovascular Research Institute Düsseldorf (CARID) Heinrich Heine University Medical Center Düsseldorf Düsseldorf Germany
| | - Carolin Helten
- Division of Cardiology, Pulmonology, and Vascular Medicine, Cardiovascular Research Institute Düsseldorf (CARID) Heinrich Heine University Medical Center Düsseldorf Düsseldorf Germany
| | - Martin Pöhl
- Division of Cardiology, Pulmonology, and Vascular Medicine, Cardiovascular Research Institute Düsseldorf (CARID) Heinrich Heine University Medical Center Düsseldorf Düsseldorf Germany
| | - Daniel Metzen
- Division of Cardiology, Pulmonology, and Vascular Medicine, Cardiovascular Research Institute Düsseldorf (CARID) Heinrich Heine University Medical Center Düsseldorf Düsseldorf Germany
| | - Philipp Mourikis
- Division of Cardiology, Pulmonology, and Vascular Medicine, Cardiovascular Research Institute Düsseldorf (CARID) Heinrich Heine University Medical Center Düsseldorf Düsseldorf Germany
| | - Christof Dücker
- Institute for Clinical Pharmacology University Medical Center GöttingenGeorg-August University Göttingen Germany
| | - Ursula Marschall
- Department of Medicine and Health Services Research BARMER Statutory Health Insurance Fund Wuppertal Germany
| | - Helmut L'Hoest
- Department of Medicine and Health Services Research BARMER Statutory Health Insurance Fund Wuppertal Germany
| | - Beata Hennig
- Department of Medicine and Health Services Research BARMER Statutory Health Insurance Fund Wuppertal Germany
| | - Saif Zako
- Division of Cardiology, Pulmonology, and Vascular Medicine, Cardiovascular Research Institute Düsseldorf (CARID) Heinrich Heine University Medical Center Düsseldorf Düsseldorf Germany
| | - Kajetan Trojovsky
- Division of Cardiology, Pulmonology, and Vascular Medicine, Cardiovascular Research Institute Düsseldorf (CARID) Heinrich Heine University Medical Center Düsseldorf Düsseldorf Germany
| | - Tobias Petzold
- Medizinische Klinik und Poliklinik I Klinikum der Universität MünchenLudwig-Maximilians- University Munich Munich Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Cardiovascular Research Institute Düsseldorf (CARID) Heinrich Heine University Medical Center Düsseldorf Düsseldorf Germany
| | - Bodo Levkau
- Institute of Molecular Medicine III University Hospital DüsseldorfHeinrich Heine University Düsseldorf Dusseldorf Germany
| | - Tobias Zeus
- Division of Cardiology, Pulmonology, and Vascular Medicine, Cardiovascular Research Institute Düsseldorf (CARID) Heinrich Heine University Medical Center Düsseldorf Düsseldorf Germany
| | - Karsten Schrör
- Institute for Pharmacology and Clinical Pharmacology Heinrich Heine University Dusseldorf Germany
| | - Thomas Hohlfeld
- Institute for Pharmacology and Clinical Pharmacology Heinrich Heine University Dusseldorf Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology, and Vascular Medicine, Cardiovascular Research Institute Düsseldorf (CARID) Heinrich Heine University Medical Center Düsseldorf Düsseldorf Germany
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Moghadami R, Vessally E, Babazadeh M, Es’haghi M, Bekhradnia A. Electronic and Work Function-Based Sensors for Acetylsalicylic Acid Based on the AlN and BN Nanoclusters: DFT Studies. J CLUST SCI 2018. [DOI: 10.1007/s10876-018-1466-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dannenberg L, Petzold T, Achilles A, Naguib D, Zako S, Helten C, M'Pembele R, Mourikis P, Podsvyadek Y, Grandoch M, Levkau B, Zeus T, Kelm M, Hohlfeld T, Polzin A. Dose reduction, oral application, and order of intake to preserve aspirin antiplatelet effects in dipyrone co-medicated chronic artery disease patients. Eur J Clin Pharmacol 2018; 75:13-20. [PMID: 30251061 DOI: 10.1007/s00228-018-2560-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/17/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Dipyrone comedication in aspirin-treated patients is associated with impaired pharmacodynamic response to aspirin (high on-treatment platelet reactivity [HTPR]). Additionally, in small observational studies, an association with impaired outcome has been described. In this uncontrolled, hypothesis-generating study, we aimed to investigate strategies to prevent this drug-drug interaction in patients with coronary artery disease (CAD). METHODS We analyzed pharmacodynamic response to aspirin in 80 dipyrone co-medicated CAD patients. Aspirin antiplatelet effects were measured using arachidonic acid (AA)-induced light-transmission aggregometry (LTA). Platelet reactivity was associated with daily dose, administration form, and frequency. Additionally, we conducted a time-series analysis in patients with HTPR to aspirin with re-evaluation of pharmacodynamic response to aspirin after 5 days. RESULTS Patients' mean age was 75.5 ± 9.8 years. Forty-three (54%) were male, 22 (27.5%) obese, and 38 (47.5%) diabetics. Baseline characteristics, cardiovascular risk factors, comorbidities, comedication, or laboratory parameters did not differ between patients with or without HTPR. HTPR to aspirin occurred in 34 out of 80 patients (42.5%). The incidence of HTPR was associated with dipyrone daily dose (< 1 g/day: HTPR 20% vs. > 3 g/day: HTPR 50%, p > 0.0001) and form of administration (i.v. 87.5% vs. oral 37.5%; p < 0.0001). A strict order of intake (aspirin 30 min prior to dipyrone) restored aspirin antiplatelet effects in all patients (HTPR before 100% vs. HTPR after 0%, p = 0.0002). CONCLUSION This study shows that dipyrone should be used with caution in aspirin-treated patients. If dipyrone seems indispensable, the lowest effective dose and a strict order of intake seem favorable.
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Affiliation(s)
- Lisa Dannenberg
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Düsseldorf, Germany.
| | - Tobias Petzold
- Department of Cardiology, LMU München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance, Munich, Germany
| | - Alina Achilles
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Düsseldorf, Germany
| | - David Naguib
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Düsseldorf, Germany
| | - Saif Zako
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Düsseldorf, Germany
| | - Carolin Helten
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Düsseldorf, Germany
| | - René M'Pembele
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Düsseldorf, Germany
| | - Philipp Mourikis
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Düsseldorf, Germany
| | - Yanina Podsvyadek
- Institute for Pharmacology and Clinical Pharmacology, Heinrich Heine University, Düsseldorf, Germany
| | - Maria Grandoch
- Institute for Pharmacology and Clinical Pharmacology, Heinrich Heine University, Düsseldorf, Germany
| | - Bodo Levkau
- West German Heart and Vascular Center, University Hospital Essen, University of Duisburg-Essen, Institute of Pathophysiology, Essen, Germany
| | - Tobias Zeus
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Düsseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Düsseldorf, Germany
| | - Thomas Hohlfeld
- Institute for Pharmacology and Clinical Pharmacology, Heinrich Heine University, Düsseldorf, Germany
| | - Amin Polzin
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Düsseldorf, Germany
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Somuncu MU, Demir AR, Karakurt H, Serbest NG, Kalayci B, Bulut U, Karakurt ST. The Relationship Between Aspirin Resistance and Carotid Imaging in Young Patients With ST-Segment Elevated Myocardial Infarction: A Cross-Sectional Study. Clin Appl Thromb Hemost 2018; 24:1358-1364. [PMID: 29888621 PMCID: PMC6714781 DOI: 10.1177/1076029618780352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The presence of carotid atherosclerosis accompanied by coronary artery disease is associated with poor prognosis. A subset of patients who take aspirin continue to have recurrent cardiovascular events, which may be due to aspirin resistance (AR). Also, carotid plaques may cause turbulent flow which in turn may lead to platelet activation and poor antiplatelet response. In our study, we aimed to show the prevalence of AR and its relationship between high-risk carotid images in young patients with ST-segment elevated myocardial infarction (STEMI). In our study, we included 112 patients younger than 45 years with STEMI. Aspirin response test was evaluated 1 hour after aspirin intake using multiplate platelet function analyzer, and carotid ultrasonography has been performed to determine carotid intima–media thickness (CIMT) and the presence of carotid plaque. We identified 30.3% AR in young patients with STEMI. Carotid intima–media thickness (P = .002), carotid plaque (P = .012), and high-risk carotid image (P = .015) values are significantly high in patients who have AR. Independent of other risk factors, the presence of carotid plaque and being in the high-risk carotid group were associated with 3.7 times and 3.2 times increased odds for AR, respectively. In young patients with STEMI, physicians should be careful about AR, especially in patients who have carotid plaque and thicker CIMT.
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Affiliation(s)
- Mustafa Umut Somuncu
- 1 Department of Cardiology, Bulent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Ali Riza Demir
- 2 Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
| | - Huseyin Karakurt
- 2 Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
| | | | - Belma Kalayci
- 1 Department of Cardiology, Bulent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Umit Bulut
- 2 Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
| | - Seda Tukenmez Karakurt
- 2 Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
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George G, Patel N, Jang C, Wheeler D, Yaddanapudi SS, Dissin J, Balu R, Rangaswami J. Proteinuria Predicts Resistance to Antiplatelet Therapy in Ischemic Stroke. Transl Stroke Res 2017; 9:130-134. [PMID: 28875481 DOI: 10.1007/s12975-017-0568-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 08/21/2017] [Accepted: 08/24/2017] [Indexed: 12/21/2022]
Abstract
The occurrence of a stroke while on antiplatelet agents presents a therapeutic dilemma. One of the main causes for recurrent strokes is antiplatelet resistance more commonly known as high on treatment platelet reactivity (HTPR). Prior studies have established that proteinuria is associated with HTPR following myocardial infarction. Here, we investigated whether dipstick proteinuria correlates with HTPR in patients presenting with stroke. We performed a retrospective cohort analysis of 102 patients admitted for a recurrent ischemic stroke that had either a VerifyNow aspirin or VerifyNow clopidogrel laboratory test performed to assess platelet reactivity. Dipstick proteinuria was defined as > 30 mg/dl (2+ or more). HTPR was defined as an aspirin resistance unit > 550 for aspirin and a P2Y12 reactivity unit > 208 for clopidogrel. Patients with proteinuria on dipstick were significantly more likely to have HTPR to either aspirin (p value 0.017) or clopidogrel (p value 0.017). After controlling for age, smoking, diabetes, hypertension, CAD and GFR, proteinuria was an independent predictor of HTPR for patient taking aspirin (p = 0.025). Platelet resistance is an entity that undermines the activity of antiplatelet agents in reducing stroke risk. Here, we demonstrate an association with increased platelet reactivity and proteinuria. This highlights a potential new therapeutic target in reducing future stroke risk.
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Affiliation(s)
- Gemlyn George
- Department of Internal Medicine, Einstein Medical Center, Klein 303, 5501 Old York Road, Philadelphia, PA, 19141, USA.
| | - Nikul Patel
- Department of Internal Medicine, Einstein Medical Center, Klein 303, 5501 Old York Road, Philadelphia, PA, 19141, USA
| | - Cecilia Jang
- Department of Internal Medicine, Einstein Medical Center, Klein 303, 5501 Old York Road, Philadelphia, PA, 19141, USA
| | - David Wheeler
- Department of Internal Medicine, Einstein Medical Center, Klein 303, 5501 Old York Road, Philadelphia, PA, 19141, USA
| | - Sridhara S Yaddanapudi
- Department of Neurosciences, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA, 19141, USA
| | - Jonathan Dissin
- Department of Neurosciences, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA, 19141, USA
| | - Ramani Balu
- Division of Neurocritical Care, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Janani Rangaswami
- Department of Internal Medicine, Einstein Medical Center, Klein 303, 5501 Old York Road, Philadelphia, PA, 19141, USA
- Sidney Kimmel College of Thomas Jefferson University, Philadelphia, PA, USA
- Delaware Valley Nephrology Associates, Philadelphia, PA, USA
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Al-Jabi SW. Global Trends in Aspirin Resistance-Related Research from 1990 to 2015: A Bibliometric Analysis. Basic Clin Pharmacol Toxicol 2017; 121:512-519. [PMID: 28667787 DOI: 10.1111/bcpt.12840] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/27/2017] [Indexed: 12/14/2022]
Abstract
Aspirin resistance can be defined as the inability of the usual dose of aspirin medication to produce its antithrombotic effect. Patients with diabetes or cardiovascular disease are at higher risk of stroke, myocardial infarction or cardiovascular death due to aspirin resistance. The aim of this bibliometric study was to identify and analyse the status and trends of aspirin resistance research production at global level through publications indexed in the Scopus database; this will shed new light on future research trends and help researchers predict dynamic direction of research. Literature search using the Scopus database was conducted to assess publications related to aspirin resistance. The selected publications included the terms related to aspirin resistance in the title, abstract or keywords. The searching was accomplished on 20 March 2016 and can be considered to include all publications up to 31 December 2015. Global cumulative publication output on aspirin resistance consists of 986 papers during 1990-2015. Among the 986 documents, 19 (1.9%) were published before 2000, 567 (57.5%) were published from 2000 to 2009 and 400 (40.6%) were published from 2010 to 2015, with peak of publications on this topic in 2008. The leading country in the field of aspirin resistance was the United States, which had the greatest counts of independent articles (165) and international collaboration articles (44). Turkey was in the second rank with 78 articles, followed by Italy (68), the UK (62) and Poland (60). The total number of citations for all documents was 26,342, and the average citations per document were 26.7. The h-index for all aspirin resistance publications was 82. This study presents the results of the first bibliometric study (including quantitative and qualitative analysis) of scientific publications in the field of aspirin renitence at global level. Aspirin resistance-related researches have notably increased in the last years, especially from 2000 to 2015. The United States is the most prolific country, not only in research quantity but also in quality. Furthermore, Turkey and European countries provided more research related to aspirin resistance than other regions such as the developing countries.
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Affiliation(s)
- Samah W Al-Jabi
- Department of Clinical and Community Pharmacy, Faulty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
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Abstract
Cardiopulmonary bypass has unpredictably deleterious effects on platelet function. Patients with cardiovascular disease have treatments aimed at reducing platelet aggregation and are at risk of excessive bleeding during surgery. Transfusion of blood products, particularly platelets, probably causes increased morbidity and mortality. Conversely, patients with excessive platelet aggregation are at risk of thrombotic complications—undesirable outcomes in the context of myocardial revascularization and prevention of stroke. Platelet function is difficult to monitor. Laboratory tests take time, and the results are not immediately available. Point-of-care (POC) testing of platelet function should facilitate the clinical management of bleeding patients by rationalizing platelet transfusion and avoiding unnecessary transfusion. Furthermore, POC platelet function could alert the clinician to risks of excessive platelet activation and measure the efficacy of antiplatelet therapy. This article outlines some of the POC platelet function monitors available as well as their potential applications.
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Affiliation(s)
- Christopher C. Harle
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada,
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10
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Aspirin resistance in cerebrovascular disease and the role of glycoprotein IIIa polymorphism in Turkish stroke patients. Blood Coagul Fibrinolysis 2016; 27:169-75. [DOI: 10.1097/mbc.0000000000000404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Polzin A, Hohlfeld T, Kelm M, Zeus T. Impairment of aspirin antiplatelet effects by non-opioid analgesic medication. World J Cardiol 2015; 7:383-391. [PMID: 26225198 PMCID: PMC4513489 DOI: 10.4330/wjc.v7.i7.383] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 05/28/2015] [Accepted: 06/16/2015] [Indexed: 02/06/2023] Open
Abstract
Aspirin is the mainstay in prophylaxis of cardiovascular diseases. Impaired aspirin antiplatelet effects are associated with enhanced incidence of cardiovascular events. Comedication with non-opioid analgesic drugs has been described to interfere with aspirin, resulting in impaired aspirin antiplatelet effects. Additionally, non-opioid analgesic medication has been shown to enhance the risk of cardiovascular events and death. Pain is very frequent and many patients rely on analgesic drugs to control pain. Therefore effective analgesic options without increased risk of cardiovascular events are desirable. This review focuses on commonly used non-opioid analgesics, interactions with aspirin medication and impact on cardiovascular risk.
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Cubero Gómez JM, Navarro Puerto MA, Acosta Martínez J, De Mier Barragán MI, Pérez Santigosa PL, Sánchez Burguillos F, Molano Casimiro F, Pastor Torres L. Assessment methods for aspirin-mediated platelet antiaggregation in type 2 diabetic patients: degree of correlation between 2 point-of-care methods. J Cardiovasc Pharmacol 2014; 64:16-20. [PMID: 24553145 DOI: 10.1097/fjc.0000000000000084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIMS Impaired response to antiplatelet therapy in diabetic patients results in a higher incidence of drug-eluting stent thrombosis. This study determined the prevalence of high on-aspirin (AS) platelet reactivity in type 2 diabetic patients treated with percutaneous coronary intervention (PCI) using the VerifyNow Aspirin Assay (VN) and platelet function analyzer PFA-100 (PFA-100) and analyzed the correlation between both methods. METHODS Type 2 diabetic patients (100) with non-ST-elevation acute coronary syndrome who underwent PCI and Xience V drug-eluting stent implantation were included in this study. After PCI, platelet antiaggregation mediated by acetylsalicylic acid was assessed by VN and PFA-100. The degree of correlation and concordance was then determined. RESULTS When assayed with VN, 7% of the patients were nonresponders to aspirin (aspirin reaction units >550), and when assayed with PFA-10, 41% were nonresponders (closure time <193 seconds). Of the patients, 4% were nonresponders to aspirin according to VN but were sensitive to aspirin according to PFA-100, and 38% were sensitive to aspirin according to VN and nonresponders according to PFA-100. Overall, 55% of the patients were aspirin-sensitive in both methods. The Spearman's coefficient between VN and PFA-100 results was r = 0.09 (P = 0.35). The kappa index value was 0.0062 (P = 0.91). CONCLUSIONS There is no concordance or correlation between the VN and PFA-100 results. Therefore, the use of these analyses should be restricted to clinical research, which limits its application in clinical practice.
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Affiliation(s)
- Jose M Cubero Gómez
- *Department of Cardiology, Hospital Universitario Virgen del Rocio, Seville, Spain; and Departments of †Internal Medicine, ‡Investigation, and §Cardiology, Hospital Universitario Virgen de Valme, Seville, Spain
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Abstract
Aspirin (acetylsalicylic acid) is one of the main therapeutic medications used in the prevention of thromboembolic vascular events. Aspirin exhibits its antiplatelet action by irreversibly inhibiting platelet cyclooxygenase-1 enzyme, thus preventing the production of thromboxane A2 (TXA2). Aspirin resistance, as measured in vitro, is the inability of aspirin to reduce platelet activation and aggregation by failure to suppress the platelet production of TXA2. Laboratory tests of platelet TXA2 production or platelet function dependent on TXA2 can detect aspirin resistance in vitro. The clinical implication of this laboratory definition has not yet been elucidated via prospective trials that have controlled for confounders, such as hypertension, diabetes and dyslipidemia. Large meta-analyses have found low-dose aspirin to be as effective as high-dose aspirin in preventing vascular events, making a dose-dependent improvement in laboratory response clinically irrelevant. Possible causes of aspirin resistance include poor compliance, inadequate dose, drug interactions, genetic polymorphisms of cyclooxygenase-1, increased platelet turnover and upregulation of non-platelet pathways of thromboxane production. However, there is currently no standardized approach to the diagnosis and no proven effective treatment for aspirin resistance. Further research exploring the mechanisms of aspirin resistance is needed in order to better define aspirin resistance, as well as to develop a standardized laboratory test that is specific and reliable, and can correlate with the clinical risk of vascular events. The intent of this paper is to review the literature discussing possible mechanisms, diagnostic testing and clinical trials of aspirin resistance and to discuss its clinical relevance as it pertains to cerebrovascular and cardiovascular disease.
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Affiliation(s)
- Darshana Patel
- Department of Neurlogy, University of Massachusetts Memorial Medical Center, Worcester, MA 01655, USA.
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Li J, Song M, Jian Z, Guo W, Chen G, Jiang G, Wang J, Wu X, Huang L. Laboratory Aspirin Resistance and the Risk of Major Adverse Cardiovascular Events in Patients with Coronary Heart Disease on Confirmed Aspirin Adherence. J Atheroscler Thromb 2014; 21:239-47. [DOI: 10.5551/jat.19521] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Dharmasaroja PA, Sae-Lim S. Comparison of aspirin response measured by urinary 11-dehydrothromboxane B2 and VerifyNow aspirin assay in patients with ischemic stroke. J Stroke Cerebrovasc Dis 2013; 23:953-7. [PMID: 24126290 DOI: 10.1016/j.jstrokecerebrovasdis.2013.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 08/01/2013] [Accepted: 08/08/2013] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND We looked for the prevalence of aspirin nonresponders, compared the results of 2 tests assessing aspirin responses-measurement of urinary 11-dehydrothromboxane B2 (dTXB2) and VerifyNow Aspirin assay-in patients with ischemic stroke, and examined the relationship of aspirin nonresponse and the outcomes of the patients. METHODS One hundred one patients with ischemic stroke were prospectively included. Aspirin response was assessed by urinary dTXB2 measurement and VerifyNow Aspirin assay. The Spearman correlation coefficients and kappa statistics were calculated to assess correlation and agreement between the 2 tests. The measured outcome was the occurrence of cardiovascular events and death. RESULTS Prevalence of aspirin nonresponders was 40% and 6%, if they were measured by urinary dTXB2 and VerifyNow Aspirin assay, respectively. Poor correlation in the results between the 2 tests was found (r = .135, P = .190). The degree of agreement between the 2 tests in relation to resistance status was weak (kappa = .032, P = .590). With a mean follow-up time of 17 months, the outcomes occurred significantly higher in aspirin nonresponders who were diagnosed by urinary dTXB2 measurement as compared with patients with aspirin response (18% versus 2%, odds ratio 8.8, 95% confidence interval 1.18-65.4, P = .037). CONCLUSIONS Our research confirmed poor correlation and lack of agreement between the 2 tests. Only aspirin nonresponders who were diagnosed by dTXB2 measurement were related to having cardiovascular events and death. Further research is still needed to identify the best method of diagnosis of aspirin nonresponders.
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Affiliation(s)
- Pornpatr A Dharmasaroja
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
| | - Suvaraporn Sae-Lim
- Research Unit, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
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DeFilippis AP, Oloyede OS, Andrikopoulou E, Saenger AK, Palachuvattil JM, Fasoro YA, Guallar E, Blumenthal RS, Kickler TS, Jaffe AS, Gerstenblith G, Schulman SP, Rade JJ. Thromboxane A(2) generation, in the absence of platelet COX-1 activity, in patients with and without atherothrombotic myocardial infarction. Circ J 2013; 77:2786-92. [PMID: 23985963 DOI: 10.1253/circj.cj-12-1421] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Aspirin's therapeutic action is via inhibition of platelet cyclooxygenase 1 (COX-1) thromboxane A2 (TxA2) production. The aim of this study was to evaluate TxA2 production, in the absence of platelet COX-1 activity, in coronary atherosclerotic heart disease patients with and without atherothrombotic myocardial infarction (MI). METHODS AND RESULTS TxA2 production, in the absence of platelet COX-1 activity, was evaluated in 44 patients taking aspirin on 3 commercially available assays that detect metabolites of TxA2 in the urine. Two assays measure urine 11-dehydro-thromboxane B2 (TxB2) alone and 1 measures urine 11-dehydro-TxB2 plus 11-dehydro-2,3-dinor-TxB2. Platelet COX-1 inhibition was confirmed on <10% platelet aggregation in response to ≥1 mmol/L arachidonic acid. Median urine 11-dehydro-TxB2 was no different in those with and without a diagnosis of atherothrombotic MI (325 vs. 311 pg/mg creatinine, P=0.59 via polyclonal ELISA) and (312 vs. 244 pg/mg creatinine, P=0.11 via LC-MS/MS). Median urine 11-dehydro-TxB2 plus 11-dehydro-2,3-dinor-TxB2, however, was higher in those with vs. those without a diagnosis of atherothrombotic MI (1,035 vs. 606 pg/mg creatinine, P=0.03 via monoclonal ELISA). CONCLUSIONS Differences in TxA2 production, in the absence of platelet COX-1 activity, between those with vs. without atherothrombotic MI were not observed when TxA2 generation was assessed on 11-dehydro-TxB2 production alone (polyclonal ELISA or LC-MS/MS), but differences were observed when TxA2 generation was assessed using 11-dehydro-TxB2 plus 11-dehydro-2,3-dinor-TxB2 (monoclonal ELISA). These findings highlight important differences between different commercially available assays for TxA2 generation and suggest that 11-dehydro-2,3-dinor-TxB2 may be critical to the biology of atherothrombosis.
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Affiliation(s)
- Andrew P DeFilippis
- University of Louisville, Rudd Heart and Lung Center/Kentucky One Health and Johns Hopkins Ciccarone Center for the Prevention of Heart Disease
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Akturk IF, Caglar FN, Erturk M, Tuncer N, Yalcın AA, Surgit O, Uzun F, Caglar IM. Hypertension as a Risk Factor for Aspirin and Clopidogrel Resistance in Patients With Stable Coronary Artery Disease. Clin Appl Thromb Hemost 2013; 20:749-54. [DOI: 10.1177/1076029613481102] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Platelets play an important role in the pathogenesis of coronary artery disease (CAD). The importance of dual antiplatelet therapy to prevent recurrent ischemic events in patients who have acute coronary syndrome and who will undergo percutaneous coronary intervention (PCI) is well known and widely accepted as a gold standard. However, despite this apparently effective therapy, incidence of adverse ischemic events could not be decreased enough. Resistance to aspirin/clopidogrel is an important risk factor for adverse ischemic clinical events. Up-to-date studies revealed many risk factors for antiplatelet resistance, one of which is hypertension (HT). Currently, there is no sufficient number of studies evaluating the association between HT and antiplatelet resistance, which is the aim of this study. Methods: We enrolled 145 consecutive patients (19 female [13.1%], 126 male [86.9%], mean age 55 ± 10) with stable CAD receiving regular antiplatelet therapy composed of 100 mg/d aspirin and 75 mg/d clopidogrel. All patients had been implanted nondrug-eluting coronary stent and/or stents at least 1 month ago. The HT was diagnosed by 24-hour blood pressure (BP) monitoring. Clopidogrel and aspirin resistance was measured by impedance aggregometry method. Results: We included 49 patients with HT and 96 nonhypertensive patients with stable CAD. Aspirin resistance was detected in 22 (16.4%) of 134 patients who received aspirin. Clopidogrel resistance was detected in 55 (37.9%) of 145 patients who received clopidogrel. Prevalance of aspirin and clopidogrel resistance was significantly higher in the hypertensive group than in the nonhypertensive group ( P = .030 and P = .007, respectively). Correlation analysis revealed weak but significantly positive correlation between clopidogrel resistance and serum uric acid levels, mean platelet volume, platelet count, and 24-hour mean systolic BP ( r = −.180, P = .030; r = .189, P = .016; r = .226, P = .006; and r = .200, P = .016, respectively). Conclusion: We demonstrated higher incidence of antiplatelet resistance in patients with HT. Upon this finding, which is emerged from an actual group of patients with HT, cardioprotective effect of antiplatelet therapy in patients with HT should be argued.
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Affiliation(s)
- Ibrahim Faruk Akturk
- Cardiology Department, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Reseach Hospital, Istanbul, Turkey
| | - Fatma Nihan Caglar
- Cardiology Department, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Reseach Hospital, Istanbul, Turkey
| | - Mehmet Erturk
- Cardiology Department, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Reseach Hospital, Istanbul, Turkey
| | - Nilgun Tuncer
- Biochemistry Department, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Reseach Hospital, Istanbul, Turkey
| | - Ahmet Arif Yalcın
- Cardiology Department, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Reseach Hospital, Istanbul, Turkey
| | - Ozgur Surgit
- Cardiology Department, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Reseach Hospital, Istanbul, Turkey
| | - Fatih Uzun
- Cardiology Department, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Reseach Hospital, Istanbul, Turkey
| | - Ilker Murat Caglar
- Cardiology Department, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Reseach Hospital, Istanbul, Turkey
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Mechanism of the irreversible inhibition of human cyclooxygenase-1 by aspirin as predicted by QM/MM calculations. J Mol Graph Model 2013; 40:99-109. [DOI: 10.1016/j.jmgm.2012.12.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 12/27/2012] [Accepted: 12/28/2012] [Indexed: 12/21/2022]
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van der Loo B, Braun J, Koppensteiner R. On-treatment Function Testing of Platelets and Long-term Outcome of Patients with Peripheral Arterial Disease Undergoing Transluminal Angioplasty. Eur J Vasc Endovasc Surg 2011; 42:809-16. [DOI: 10.1016/j.ejvs.2011.08.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 08/17/2011] [Indexed: 11/27/2022]
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FitzGerald R, Pirmohamed M. Aspirin resistance: Effect of clinical, biochemical and genetic factors. Pharmacol Ther 2011; 130:213-25. [DOI: 10.1016/j.pharmthera.2011.01.011] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 01/18/2011] [Indexed: 01/08/2023]
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Gao G, Zheng Z, Pi Y, Lu B, Lu J, Hu S. Aspirin plus clopidogrel therapy increases early venous graft patency after coronary artery bypass surgery a single-center, randomized, controlled trial. J Am Coll Cardiol 2011; 56:1639-43. [PMID: 21050973 DOI: 10.1016/j.jacc.2010.03.104] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 02/22/2010] [Accepted: 03/18/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We sought to evaluate the effect of aspirin plus clopidogrel versus aspirin alone on saphenous vein graft occlusion at 3 months after coronary artery bypass grafting (CABG). BACKGROUND Prevalence of graft occlusion is high after CABG. Aggressive antiplatelet therapy is expected to improve early post-operative graft patency. METHODS From December 2007 through December 2008, 249 consecutive patients undergoing elective CABG at Fuwai Hospital were randomly assigned to 2 groups: 124 received aspirin (100 mg) plus clopidogrel (75 mg) daily (AC group), and 125 received aspirin (100 mg) alone daily (A group). Antiplatelet therapies were initiated when post-operative chest tube drainage was ≤ 30 cc/h for 2 h. All participants were invited for clinical follow-up and 64-slice multislice computed tomography angiography (MSCTA) analysis at 3 months post-operatively. Generalized estimating equations analysis was used to determine predictors of graft patency. RESULTS One participant, from group A, died before 3-month follow-up. Of the remaining 248 patients, 224 (90.3%) underwent MSCTA. Participants had similar pre-operative and intraoperative characteristics at baseline. No significant differences were observed in intraoperative transit-time flow measurement findings or major adverse cardiac-related events. Three-month MSCTA follow-up revealed that saphenous vein graft patency was 91.6% (219 of 239) in the AC group versus 85.7% (198 of 231) in the A group (p = 0.043). In multivariate analysis, combined antiplatelet therapy independently increased venous graft patency (p = 0.045). CONCLUSIONS Aspirin plus clopidogrel is more effective in venous graft patency than aspirin alone in the short term after CABG, but further, long-term study is needed. (The Clopidogrel and Aspirin After Surgery for Coronary Artery Disease; NCT00776477).
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Affiliation(s)
- Ge Gao
- Department of Surgery, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, The People's Republic of China
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Effects of different doses, enteric-coated preparation of aspirin, and sex on urinary 11-dehydrothromboxane B2 in healthy volunteers. Blood Coagul Fibrinolysis 2010; 21:649-52. [DOI: 10.1097/mbc.0b013e32833cea2c] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Mark J Alberts
- Department of Neurology, Northwestern University Feinberg School of Medicine, and the Stroke Program, Northwestern Memorial Hospital, Chicago, Ill, USA.
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Abstract
Genetic polymorphisms may affect platelets' responses to the antiplatelet therapy. Our aim was to determine the role of genetic polymorphisms on aspirin resistance in patients with coronary heart disease (CHD). A total of 126 consecutive patients (35-85 years old, 32% women) with chronic stable CHD was enrolled in the study. Platelet function assays were realized by the platelet function analyzer (PFA)-100 with collagen and epinephrine (Col/Epi) and collagen and adenosine diphosphate (Col/ADP) cartridges. Aspirin resistance was defined as having a closure time of less than 186 s with Col/Epi cartridges despite regular aspirin therapy. Factor V, prothrombin, factor XIII, beta-fibrinogen, plasminogen activator inhibitor I (PAI-1), glycoprotein IIIa, methylene tetrahydrofolate reductase, ACE and ApoB gene polymorphisms were determined by three consecutive steps: isolation and amplification of DNA and reverse hybridization. We determined that 30 patients (23.8%) had aspirin resistance by the PFA-100. Mean closure time measured with the Col/ADP cartridges was 74 +/- 12 s (51-104 s). Ten of the 30 patients with aspirin resistance were women (33.3%). Genetic polymorphisms were determined in 30 aspirin-resistant and 17 aspirin-sensitive patients. No statistically significant relationship was determined between aspirin resistance and the genetic panel. In our study we did not determine a significant relationship between the aspirin resistance and factor V, prothrombin, factor XIII, beta-fibrinogen, PAI-1, glycoprotein IIIa, methylene tetrahydrofolate reductase, ACE and ApoB gene polymorphisms.
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Resistencia a la aspirina: prevalencia, mecanismos de acción y asociación con eventos tromboembólicos. Revisión narrativa. FARMACIA HOSPITALARIA 2010; 34:32-43. [DOI: 10.1016/j.farma.2009.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Revised: 07/30/2009] [Accepted: 08/07/2009] [Indexed: 11/23/2022] Open
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Saraf S, Bensalha I, Gorog D. Antiplatelet Resistance—Does it Exist and how to Measure it? Clin Med Cardiol 2009. [DOI: 10.4137/cmc.s2159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aspirin and clopidogrel are the most commonly used antiplatelet agents in patients with coronary artery disease. The existence of resistance to these agents has been a controversial issue and new drugs are being developed to overcome this problem. Laboratory tests, which can identify resistance and correlate this with clinical outcome, are being studied in order to identify patients at risk of future thrombotic events. We discuss the evidence for the existence of antiplatelet resistance—both in the laboratory and in the clinical setting. So far, platelet aggregometry has been considered the gold standard test, but is very operator dependant, time consuming, and has shown little correlation with other available tests of antiplatelet resistance. We discuss the available tests of platelet function, their limitations, and evidence for their use. A simple, rapid, near-patient test, which is affordable and useful in the clinical (not just laboratory) setting, could allow risk stratification of patients and individualization of antiplatelet medication to improve outcome.
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Affiliation(s)
- S. Saraf
- Cardiology Department, East and North Hertfordshire NHS Trust, UK
| | - I. Bensalha
- Cardiology Department, East and North Hertfordshire NHS Trust, UK
| | - D.A. Gorog
- Cardiology Department, East and North Hertfordshire NHS Trust, UK
- Imperial College, London, UK
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Gibbs NM. Point-of-care assessment of antiplatelet agents in the perioperative period: a review. Anaesth Intensive Care 2009; 37:354-69. [PMID: 19499855 DOI: 10.1177/0310057x0903700317] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The aim of this paper was to review the strengths and limitations of current 'point-of-care' techniques for the detection of antiplatelet drug effects. The review was based on a Medline search for articles with key words related to "platelet function tests", "point-of-care", and "anaesthesia", published in English between January 1996 and September 2008. It was found that global assessments of 'haemostasis', such as the standard thrombelastograph, Sonoclot, Clot Signature Analyser and Hemodyne, are not specific for platelet function and are essentially insensitive to cyclooxygenase inhibitors (aspirin, non-steroidal anti-inflammatory drugs) and P2Y12 antagonists (ticlopidine, clopidogrel). Global assessments of 'platelet function', such as the PFA-100 and PlateletWorks, are more specific for platelet function, but also have limited sensitivity for cyclooxygenase inhibitors and P2Y12 antagonists. The newer devices developed specifically for the assessment of antiplatelet drugs, such as Platelet Mapping, the Impact Cone and Platelet Analyser and the VerifyNow, are more promising, but are not as sensitive as laboratory platelet aggregometry. All three categories of devices detect G(p)II(b)/III(a) antagonists (abciximab, tirofiban, eptifibatide) activity, but not all provide quantitative assessments for monitoring therapy. The limitations appeared to be related to the complexity of platelet function, the multiple pathways of platelet activation, the wide interpatient variability in platelet responses and the interdependence between platelets and other aspects of coagulation. The strengths and limitations of point-of-care devices should be appreciated before they are used to assist clinical decision-making in the perioperative period.
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Affiliation(s)
- N M Gibbs
- Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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Cola C, Brugaletta S, Martín Yuste V, Campos B, Angiolillo DJ, Sabaté M. Diabetes mellitus: a prothrombotic state implications for outcomes after coronary revascularization. Vasc Health Risk Manag 2009; 5:101-19. [PMID: 19436654 PMCID: PMC2672443 DOI: 10.2147/vhrm.s4248] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Coronary stent thrombosis is a serious problem in the drug-eluting stent era. Despite aggressive antiplatelet therapy during and after percutaneous coronary intervention (PCI), the incidence of sub-acute stent thrombosis remains approximately 0.5%–2%, which may represent a catastrophic clinical situation. Both procedural factors and discontinuation of antiplatelet therapy are normally associated with this event. We report on simultaneous stent thromboses of two drug-eluting stents implanted in two different vessels, which resulted in a life-threatening clinical condition. Possible contributing factors that led to synergistic thrombotic effects are discussed.
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Affiliation(s)
- Clarissa Cola
- Department of Cardiology, Interventional Cardiology Unit, Sant Pau University Hospital, Barcelona, Spain
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Li JB, Dong HM, Jian Z, Wu XJ, Zhao XH, Yu SY, Huang L. Responsiveness to aspirin in patients with unstable angina pectoris by whole blood aggregometry. Int J Clin Pract 2009; 63:407-16. [PMID: 19222626 DOI: 10.1111/j.1742-1241.2008.01976.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AIMS To evaluate aspirin responsiveness in patients with unstable angina pectoris (UAP) by whole blood aggregometry. Another goal was to differentiate aspirin-resistant patients into pharmacokinetic or pharmacodynamic type. METHODS We measured platelet aggregation by determining impedance values in 70 normal volunteers and 104 UAP patients on aspirin (100 mg/day > or = 7 days) in four inducing conditions [1 microg/ml collagen, 2 microg/ml collagen, 5 micromol/l adenosine diphosphate (ADP) and 10 micromol/l ADP]. We calculated a cut-off value based on data from normal volunteers to define aspirin responsiveness in cases. Then, the correlation and agreement between the results in the four conditions was analysed to choose a preferred inducing condition for identification of aspirin resistance. Aliquots from all samples were incubated with 0.1 mmol/l aspirin and measured again for aspirin-resistant classification. RESULTS Aspirin resistance was observed in 38 patients (36.5%), 51 patients (49.0%), 67 patients (64.4%) and 67 patients (64.4%), respectively, for 1 microg/ml collagen, 2 microg/ml collagen, 5 micromol/l ADP and 10 micromol/l ADP among 104 patients. Collagen at low concentration was suggested as a preferred agent for detecting aspirin inhibitory effect according to the coefficient of sensitivity. After incubation, only three among 38 aspirin-resistant patients showed normal platelet aggregation and were classified into pharmacodynamic type. CONCLUSIONS In the presence of collagen at low concentration (1 microg/ml), the prevalence of aspirin resistance is about 36.5% in UAP patients, and according to a classification specific for resistant patients, most of the aspirin 'resistance' is just because of pharmacokinetic issues.
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Affiliation(s)
- J B Li
- Institute of Cardiovascular Science, Xinqiao Hospital, Third Military Medical University, Chongqing, China
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Bibliography. Current world literature. Imaging and echocardiography. Curr Opin Cardiol 2008; 23:512-5. [PMID: 18670264 DOI: 10.1097/hco.0b013e32830d843f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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van Westrhenen R, Gispen-de Wied CC, Lekkerkerker JFF. Blunting of the Cardiovascular Effect of Aspirin by Ibuprofen: What Is the Evidence? Clin Pharmacol Ther 2008; 83:812; author reply 812-3. [DOI: 10.1038/sj.clpt.6100338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Dharmasaroja P. Baseline Characteristics of Patients With Acute Ischemic Stroke in a Suburban Area of Thailand. J Stroke Cerebrovasc Dis 2008; 17:82-5. [DOI: 10.1016/j.jstrokecerebrovasdis.2007.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Revised: 11/08/2007] [Accepted: 11/09/2007] [Indexed: 10/22/2022] Open
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Berger JS, Brown DL, Becker RC. Low-dose aspirin in patients with stable cardiovascular disease: a meta-analysis. Am J Med 2008; 121:43-9. [PMID: 18187072 DOI: 10.1016/j.amjmed.2007.10.002] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Revised: 10/09/2007] [Accepted: 10/10/2007] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Many recommendations for aspirin in stable cardiovascular disease are based on analyses of all antiplatelet therapies at all dosages and in both stable and unstable patients. Our objective was to evaluate the benefit and risk of low-dose aspirin (50-325 mg/d) in patients with stable cardiovascular disease. METHODS Secondary prevention trials of low-dose aspirin in patients with stable cardiovascular disease were identified by searches of the MEDLINE database from 1966 to 2006. Six randomized trials were identified that enrolled patients with a prior myocardial infarction (MI) (n=1), stable angina (n=1), or stroke/transient ischemic attack (n=4). A random effects model was used to combine results from individual trials. RESULTS Six studies randomized 9853 patients. Aspirin therapy was associated with a significant 21% reduction in the risk of cardiovascular events (nonfatal MI, nonfatal stroke, and cardiovascular death) (95% confidence interval [CI], 0.72-0.88), 26% reduction in the risk of nonfatal MI (95% CI, 0.60-0.91), 25% reduction in the risk of stroke (95% CI, 0.65-0.87), and 13% reduction in the risk of all-cause mortality (95% CI, 0.76-0.98). Patients treated with aspirin were significantly more likely to experience severe bleeding (odds ratio 2.2, 95% CI, 1.4-3.4). Treatment of 1000 patients for an average of 33 months would prevent 33 cardiovascular events, 12 nonfatal MIs, 25 nonfatal strokes, and 14 deaths, and cause 9 major bleeding events. Among those with ischemic heart disease, aspirin was most effective at reducing the risk of nonfatal MI and all-cause mortality; however, among those with cerebrovascular disease, aspirin was most effective at reducing the risk of stroke. CONCLUSION In patients with stable cardiovascular disease, low-dose aspirin therapy reduces the incidence of adverse cardiovascular events and all-cause mortality, and increases the risk of severe bleeding.
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Kang MY, Cho YM, Kim HK, An JH, Ahn HY, Yoon JW, Choi HS, Lee JS, Park KS, Kim SY, Lee HK. Prevalence and Clinical Characteristics of Aspirin Resistance in the Patients with Type 2 Diabetes Mellitus. KOREAN DIABETES JOURNAL 2008. [DOI: 10.4093/kdj.2008.32.1.53] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Mi Yeon Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Korea
| | - Young Min Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Korea
| | - Hyun Kyung Kim
- Department of Laboratory Medicine, Seoul National University College of Medicine, Korea
| | - Jee Hyun An
- Department of Internal Medicine, Seoul National University College of Medicine, Korea
| | - Hwa Young Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, Korea
| | - Ji Won Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Korea
| | - Hoon Sung Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Korea
| | - Jie Seon Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Korea
| | - Kyong Soo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Korea
| | - Seong Yeon Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Korea
| | - Hong Kyu Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Korea
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Bode C, Zehender M. The use of antiplatelet agents following percutaneous coronary intervention: focus on late stent thrombosis. Eur Heart J Suppl 2007. [DOI: 10.1093/eurheartj/sum018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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