Aspirin resistance and ischemic heart disease on Iranian experience

Aspirin and clopidogrel resistance; a neglected gap in stroke and cardiovascular practice in Iran: a systematic review and meta-analysis

OBJECTIVE

Antiplatelet drugs, such as Aspirin and Clopidogrel (Plavix) are effective in the primary prevention of thromboembolic events. They are commonly used to reduce the risk of recurrence of thromboembolism. The body's hemostatic system responds differently to these drugs in different people. Resistance testing for aspirin and Clopidogrel is now recommended before starting antiplatelet therapy.

METHODS

A systematic literature search was performed on May 12, 2021, using the medical search engines PubMed, Scopus, and Web of Science, and the local databases SID and Magiran. After data extraction, a meta-analysis was performed using Comprehensive Meta-Analysis (CMA2) software. The I2 statistic was used to measure heterogeneity between estimates.

RESULTS

Among the 949 papers, Clopidogrel resistance was assessed in 136 patients and Aspirin resistance in 400 patients. The prevalence of Aspirin resistance was found to be 52.1% and the prevalence of Clopidogrel resistance was found to be 20.5%.

CONCLUSION

It seems that in Iran, the issue of Aspirin and Clopidogrel resistance is suboptimally addressed. This pattern could also occur in other developing countries in the Middle East region.

Metabolic activity and pathway study of aspirin biodegradation using a microbial electrochemical system supplied by an alternating current

The main aim of this study is to investigate the biodegradation of highly concentrated aspirin as an emerging pollutant from aqueous solution using an alternating current microbial electrochemical system. A single-chamber Plexiglas cylindrical reactor equipped with stainless steel mesh electrodes (18 cm height × 16 cm diameter) was applied as the bioreactor in batch mode with an effective volume of 5 L, height of 20 cm, and the diameter about 20 cm by AMPL = 2 V_pp, OFST = 0.1 V, waveform = sinusoidal, frequency = 10 Hz, and pH = 7. The process parameters including initial concentration (100-400 mg L^-1), chemical oxygen demand (COD), activity of enzymes, biokinetic and pathway studies at very low voltage and very low frequency alternating current were investigated. The specific biodegradation rate of aspirin was calculated based on Michaelis-Menten model. The complete aspirin removal efficiency and the maximum enzymatic activity were achieved at 250 mg L^-1 aspirin, voltage of 2 V_pp and applied current = 3 mA during 6 h. The bioassay of aspirin concentrations in biofilm of the system using flow cytometry analysis resulted in the live and necrotic cells shares of 96.2%, and 0.44%, respectively. Moreover, the LC and GC-MS analysis showed low molecular weight acids such as oxalic and acetic acid at 6 h time under the optimal conditions using very low applied voltage and frequency. Obtaining low reaction time for degradation, high potential in biodegradation, oxidation and mineralization ability were the novelty of treatment system with high concentration aspirin in the study.

rs5911 and rs3842788 Genetic Polymorphism, Blood Stasis Syndrome, and Plasma TXB2 and hs-CRP Levels Are Associated with Aspirin Resistance in Chinese Chronic Stable Angina Patients

The identification of single nucleotide polymorphisms (SNPs) related to aspirin resistance (AR) is of great significance for the explanation why some individuals demonstrate an incomplete response to aspirin and for optimizing the antiplatelet therapy strategy. The study was designed to investigate the possible associated genetic markers and clinical factors of AR for Chinese patients with chronic stable angina after PCI and to analyze the association between TXA2, PGI2, hs-CRP level, AR, and gene polymorphisms. Totally 207 chronic stable angina patients who received 100 mg maintenance dose daily of aspirin for more than 7 days were enrolled. The inhibition of platelets was assessed using light transmittance aggregometry. TXB2, 6-keto-PGF1α, and hs-CRP were measured by radioimmunoassay. Genotyping was performed using Taqman probe technique (rs5787 and rs5911) and gene sequencing technology (rs3842788). By using binary logistic regression analysis, the impact of clinical and genetic determinants on AR was evaluated. The prevalence of AR and aspirin semiresistance (ASR) was 3.86% and 20.76%, respectively, in Chinese chronic stable angina patients. rs5911 A/C and C/C versus A/A genotype (OR = 5.546, 95% CI = 1.812–11.404), rs3842788 A/G versus G/G genotype (OR = 8.358, 95% CI = 2.470–28.286), and blood stasis syndrome (BSS, OR = 10.220, 95% CI = 4.242–24.621) were associated with AR, but rs5787 variants were all homozygous of G/G genotype. Plasma TXB2 and hs-CRP increased significantly in AR and ASR group, while 6-keto-PGF1α showed no difference, and TXB2 level was significantly higher in carriers of the rs3842788 A/G genotype. According to our results, rs5911 and rs3842788 are proved to be specific genetic markers of AR in Chinese chronic stable angina patients for the first time, and BSS was also proved to be a remarkable determinant for AR. The AR and ASR patients were with increased plasma TXB2 and hs-CRP levels, and the TXB2 level was influenced by the variation of rs3842788 genotype.