The incidence of aspirin resistance in heart transplantation recipients

Urbanowicz, Tomasz; Komosa, Anna; Michalak, Michał; Mularek, T; Cassadei, Veronica; Grajek, Stefan; Jemielity, Marek

doi:10.5114/kitp.2017.68742

Cited by 3 publications

(5 citation statements)

References 29 publications

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“…Early use of aspirin has been shown to reduce the incidence of coronary allograft vasculopathy, a significant contributor to morbidity and mortality . Aspirin resistance is relatively common, including among heart transplant recipients . Dipyridamole has not been noted to decrease the activity of commonly used immunosuppressants, unlike clopidogrel or ticlopidine …”

Section: Discussionmentioning

confidence: 99%

Impact of dipyridamole on adenosine dosing in pediatric and young adult patients after heart transplantation

Satzer

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Zuckerman

et al. 2020

Pediatric Transplantation

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Background Relative contraindications to adenosine use have included heart transplant and dipyridamole. We previously demonstrated the safety and efficacy of adenosine‐induced atrioventricular (AV) block in healthy young heart transplant recipients while suspending dipyridamole therapy (dual antiplatelet agent). This prospective follow‐up study evaluated the safety and efficacy of adenosine use in the same cohort of heart transplant recipients while on dipyridamole. Methods Adenosine was incrementally dosed until AV block occurred (maximum 200 mcg/kg up to 12 mg). The primary outcome was clinically significant asystole (≥12 seconds). Secondary outcomes included maximal adenosine dose, AV block duration, dysrhythmias, and clinical symptoms. Outcomes were compared to the parent study. Results Thirty of 39 eligible patients (5‐24 years) were tested. No patient (0%, CI 0%‐8%) experienced clinically significant asystole. AV block occurred in 29/30 patients (97%, CI 86%‐100%). The median dose causing AV block was 50mcg/kg (vs 100 mcg/kg off dipyridamole; P = .011). Seventeen patients (57%, CI 39%‐72%) required less adenosine to achieve AV block on dipyridamole; six (20%) required more. AV block occurred at doses ≥25 mcg/kg in all patients. In pairwise comparison to prior testing off dipyridamole, no significant change occurred in AV block duration, frequency of cardiac ectopy, or incidence of reported symptoms. No atrial fibrillation/flutter occurred. Conclusions AV block often occurs at twofold lower adenosine doses in healthy young heart transplant recipients taking oral dipyridamole, compared with previous testing of this cohort off dipyridamole. Results suggest that initial dosing of 25 mcg/kg (maximum 0.8 mg) with stepwise escalation poses low risk of prolonged asystole on dipyridamole.

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Section: Discussionmentioning

confidence: 99%

Impact of dipyridamole on adenosine dosing in pediatric and young adult patients after heart transplantation

Satzer

Flyer

Zuckerman

et al. 2020

Pediatric Transplantation

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“…5 Howev-er, aspirin does not always prevent the formation of thromboxane A2 due to failure to inhibit platelet COX. 6 Because of that, all individuals do not respond to antiplatelet therapy in a similar way. In this sense, the genetic mutations have been related with aspirin resistance (AR) and may cause reduction or increase in drug absorption and metabolism, contributing to AR.…”

Section: Introductionmentioning

confidence: 99%

“…In this sense, the genetic mutations have been related with aspirin resistance (AR) and may cause reduction or increase in drug absorption and metabolism, contributing to AR. 6,7 Aspirin resistance can be diagnosed by clinical criteria or by laboratory tests. Clinically, the patient has a new episode of CVD, despite the regular use of aspirin.…”

Section: Introductionmentioning

confidence: 99%

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Impact of pharmacogenetics on aspirin resistance: a systematic review

et al. 2023

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Background Pharmacogenetics promises better control of diseases such as cardiovascular disease (CVD). Acetylsalicylic acid, aspirin, prevents the formation of an activating agent of platelet aggregation and vasoconstriction, and it is used to prevent CVD. Nevertheless, patients may have treatment failure due to genetic variants that modify the metabolism of the drug causing aspirin resistance (AR). Objectives To realize a systematic literature review to determine the impact of genetic variants on AR. Methods Articles published in the MEDLINE/PubMed, Cochrane, Scopus, LILACS, and SCIELO databases were systematically screened. A total of 290 articles were identified and 269 articles were excluded because they did not comply with the previously established inclusion criteria. A total of 20 case-control studies and 1 cohort was included. Results The genetic variants rs1126643 (ITGA2), rs3842787 (PTGS1), rs20417 (PTGS2), and rs5918 (ITGB3) were the most studied. As for relevance, of the 64 genetic variants evaluated by the articles, 14 had statistical significance (p < 0.05; 95% confidence interval [CI]) in at least one article. Among them, the following have had unanimous results: rs1371097 (P2RY1), rs1045642 (MDR1), rs1051931 and rs7756935 (PLA2G7), rs2071746 (HO1), rs1131882 and rs4523 (TBXA2R), rs434473 (ALOX12), rs9315042 (ALOX5AP), and rs662 (PON1), while these differ in real interference in AR: rs5918 (ITGB3), rs2243093 (GP1BA), rs1330344 (PTGS1), and rs20417 (PTGS2). As study limitations, we highlight the nonuniform methodologies of the analyzed articles and population differences. Conclusion It is noteworthy that pharmacogenetics is an expanding area. Therefore, further studies are needed to better understand the association between genetic variants and AR.

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“…Aspirin cannot always prevent the formation of TXA2 or completely inhibit the activation of COX receptor on platelets. Therefore, some patients undergoing antiplatelet therapy will still experience thrombotic events [3] , which we refer as Aspirin Resistance (AR) or aspirin hyporesponsiveness. AR refers to the failure of aspirin to achieve the expected pharmacological effect, for instance, inhibition of platelet activity or prevention of ischemic events [4,5] .…”

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confidence: 99%

Impact of Xuefu Zhuyu Decoction on Reducing Hyporesponsiveness of Aspirin in Acute Coronary Syndrome

Yu,

Zhu,

Sun

et al. 2024

IJPS

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The main objective of this study is to evaluate the effect of Xuefu Zhuyu decoction on aspirin resistance in acute coronary syndrome patients. We enrolled 45 patients with aspirin resistance and divided them randomly into control group (group A) and treatment group (group B). We applied Xuefu Zhuyu decoction to the group B for 4 w. Before treatment and after 4 w of treatment, we evaluated the platelet reactivity, and performed biochemical and molecular biology analyses from both subgroups. Through logistic regression analysis, we assessed the association between improvement of platelet function and confounding factors. Lastly, clinical follow-ups for 1 mo and 12 mo were performed to analysis the therapeutic effects. We found the aspirin reaction unit was clearly on decline 602.35±26.49 vs. 542.48±43.09 (before treatment vs. after treatment; p<0.001) in group B. Through quantitative reverse transcription-polymerase chain reaction and radioimmunoassay, we assessed the expression of cyclooxygenase-1 and thromboxane A2, and the results indicated that after treatment, the thromboxane A2 decreased 503.4±12.0 vs. 447.8±48.5 (before treatment vs. after treatment; p<0.001). In group B, hemorheology improved significantly, and plasma viscosity, whole blood viscosity along with fibrinogen decreased significantly (all p<0.01). Meanwhile, in group B, the glucose was correlated with aspirin reaction unit and the expression of thromboxane A2 was a protective factor of aspirin reaction unit, and aspirin resistance patients would suffer less major adverse cardiac events (p=0.024). Xuefu Zhuyu decoction might reduce hyporesponsiveness of aspirin by inhibiting thromboxane A2 and improve the hemorheological index, which are of great significance for the prevention in cardiovascular events.

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The incidence of aspirin resistance in heart transplantation recipients

Cited by 3 publications

References 29 publications

Impact of dipyridamole on adenosine dosing in pediatric and young adult patients after heart transplantation

Impact of dipyridamole on adenosine dosing in pediatric and young adult patients after heart transplantation

Impact of pharmacogenetics on aspirin resistance: a systematic review

Impact of Xuefu Zhuyu Decoction on Reducing Hyporesponsiveness of Aspirin in Acute Coronary Syndrome

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