The frequency of aspirin resistance and its risk factors in patients with metabolic syndrome

Kahraman, Göksel; Şahı̇n, Tayfun; Kılıç, Teoman; Baytugan, Nart Zafer; Ağaçdiken, Ayşen; Ural, Ertan; Ural, Dilek; Komşuoğlu, Baki

doi:10.1016/j.ijcard.2006.10.025

Cited by 22 publications

(23 citation statements)

References 38 publications

(40 reference statements)

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“…In the study by Goksel et al ., this trend is clearly seen. [4] Current available data shows that about 4-30% of patients treated with conventional doses of clopidogrel do not display adequate antiplatelet response. Intrinsic mechanisms include genetic polymorphisms of the P2Y 12 receptor and of the CYP3As, accrued release of adenosine diphosphate, or upregulation of other platelet activation pathways.…”

Section: Introductionmentioning

confidence: 99%

Study of platelet aggregation in acute coronary syndrome with special reference to metabolic syndrome

Paul

Banerjee

Guha

et al. 2013

Int J App Basic Med Res

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Background/Context:Antiplatelet drug resistance increases the risk of adverse events like stent thrombosis in acute coronary syndrome (ACS). Metabolic syndrome (MS) is a prothrombotic state and presence of MS further increases the risk of antiplatelet drug resistance.Aims and Objectives:We studied platelet aggregation characteristics in patients of ACS for aspirin or clopidogrel resistance. We studied the relation of drug resistance with blood markers like high sensitivity C-reactive protein (hsCRP). We also studied for any relation of drug resistance with presence of MS.Materials and Methods:We studied platelet aggregation characteristics by optical aggregometry using platelet-rich plasma (PRP) of patients. Collagen (2 μg/mL) and adenosine diphosphate (ADP; 10 μmol) were used. Greater than 50% aggregation in PRP of patients was taken as an evidence of drug resistance. Suitable blood tests were done including newer risk markers like hsCRP, apolipoprotein B, and fibrinogen.Statistical test:Statistical tests included Student's t-test and Kendall's rank correlation coefficient.Results:We had a total of 94 patients of ACS with 47 (50%) having MS. MS patients showed higher blood levels of hsCRP and fibrinogen. Twenty-eight (59.5%) patients with MS showed antiplatelet drug resistance compared to 12 patients without MS. Serum fibrinogen showed strongest correlation with drug resistance. HsCRP levels showed correlation with aspirin resistance (r = 0.53) only in the MS group.Discussion and Conclusion:We found significantly high prevalence of antiplatelet drug resistance. Aspirin and clopidogrel resistance was comparable. MS was a significant risk factor for drug resistance. The prothrombotic and proinflammatory markers showed strong correlation with drug resistance. A larger randomized trial is needed to better characterize this clinical problem.

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Section: Introductionmentioning

confidence: 99%

Study of platelet aggregation in acute coronary syndrome with special reference to metabolic syndrome

Paul

Banerjee

Guha

et al. 2013

Int J App Basic Med Res

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“…This has raised the possibility that these patients may be resistant to aspirin and generated much interest in identification of such patients with laboratory tests of platelet function. Although many studies have demonstrated aspirin resistance in cardiovascular disorders including coronary artery disease [8,9], metabolic syndrome [10], and diabetes [11][12][13] by certain tests of aspirin resistance, there are still concerns that these tests have not correlated closely with subsequent recurrent events, and have not reliably identified non-responders to antiplatelet therapy [14][15][16]. In addition to the absence of any standardized approach to the diagnosis, there is currently no proven effective treatment for aspirin resistance.…”

Section: Introductionmentioning

confidence: 99%

Aspirin resistance in patients with acute ischemic stroke

Özben

Tanrikulu

et al. 2011

J Neurol

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Aspirin is used in ischemic stroke therapy. However, some patients are not responsive to the antithrombotic action of aspirin. The aim of this study was to assess the prevalence of aspirin resistance in stroke patients and its association with mortality. One-hundred and six patients (mean age 64.9 ± 14.6 years, 53 male) with acute ischemic stroke were consecutively recruited. All subjects were taking aspirin regularly. Aspirin responsiveness was determined by Ultegra Rapid Platelet Function Assay-ASA (VerifyNow Aspirin). Aspirin resistance was defined as aspirin reaction unit (ARU) ≥ 550. Aspirin resistance was detected in 35 patients. There were not any significant differences in age, gender and comorbidities between aspirin-resistant and aspirin-sensitive patients. The mean National Institute of Health Stroke Scale (NIHSS) scores of the aspirin-resistant and aspirin-sensitive patients were 15 ± 3 and 12 ± 5, respectively (p = 0.006). Twenty-seven patients had a history of prior ischemic stroke and eight of them had aspirin resistance. Eleven patients died in-hospital and a total of 43 patients died during 2 years. Both the in-hospital and 2-year mortality rates were significantly higher in patients with aspirin resistance (20 vs. 5.6%, p = 0.038 and 60.0 vs. 31.0%, p = 0.004, respectively). Regression analysis revealed aspirin resistance [odds ratio (OR) 3.097, 95% confidence interval (CI) 1.070-8.959, p = 0.037] as an independent predictor of 2-year mortality, as well as age (OR 1.051, 95% CI 1.003-1.102, p = 0.038) and NIHSS scores (OR 1.208, 95% CI 1.016-1.437, p = 0.033). Aspirin resistance is not uncommon in patients with acute ischemic stroke and is associated with short and long term mortality in these patients.

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“…Previously, investigations have found that inhibition of the function of platelets by aspirin is diminished in metabolic syndrome. 32, 33, 40, 41 However, platelet function assays ( e.g., ADP- and collagen-induced aggregation, PFA-100 ® , and VerifyNow ® ) indirectly measure the net effects of both thromboxane-dependent and thromboxane-independent pathways. Although these tests may provide information about platelet reactivity, they cannot determine the success or failure of aspirin to inhibit platelet COX-1 in an individual patient.…”

Section: Discussionmentioning

confidence: 99%

Suboptimal Inhibition of Platelet Cyclooxygenase-1 by Aspirin in Metabolic Syndrome

et al. 2012

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Interindividual variation in the ability of aspirin to inhibit platelet cyclooxygenase-1 (COX-1) could account for some on-treatment cardiovascular events. Here, we sought to determine whether there are clinical phenotypes that are associated with a suboptimal pharmacological effect of aspirin. In a prospective, 2-week study, we evaluated the effect of aspirin 81 mg on platelet COX-1 in 135 patients with stable CAD by measuring serum thromboxane B2 (sTxB2) as an indicator of inhibition of platelet COX-1. A nested randomized study compared enteric-coated with immediate-release formulations of aspirin. We found that sTxB2 was systematically higher among the 83 patients with metabolic syndrome than among the 52 patients without (median 4.0 ng/mL vs. 3.02 ng/mL, P=0.013). Twelve (14%) patients with metabolic syndrome, but none without metabolic syndrome, had sTxB2 levels consistent with inadequate inhibition of COX (sTxB2 ≥13 ng/mL). In linear regression models, metabolic syndrome (but none of its individual components) significantly associated with higher levels of log-transformed sTxB2 (P=0.006). Higher levels of sTxB2 associated with greater residual platelet function measured by aggregometry-based methods. Among the randomized subset, sTxB2 levels were systematically higher among patients receiving enteric-coated aspirin. Last, urinary 11-dehydrothromboxane B2 did not correlate with sTxB2, suggesting that the former should not be used to quantitate aspirin’s pharmacological effect on platelets. In conclusion, metabolic syndrome, which places patients at high risk for thrombotic cardiovascular events, strongly and uniquely associates with less effective inhibition of platelet COX-1 by aspirin.

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The frequency of aspirin resistance and its risk factors in patients with metabolic syndrome

Cited by 22 publications

References 38 publications

Study of platelet aggregation in acute coronary syndrome with special reference to metabolic syndrome

Study of platelet aggregation in acute coronary syndrome with special reference to metabolic syndrome

Aspirin resistance in patients with acute ischemic stroke

Suboptimal Inhibition of Platelet Cyclooxygenase-1 by Aspirin in Metabolic Syndrome

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