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ANTIPLATELET THERAPY RESISTANCE IN PATIENTS WITH ACUTE CORONARY SYNDROME WITH ST-SEGMENT ELEVATION

https://doi.org/10.20996/1819-6446-2008-4-2-23-29

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Abstract

Aim. To evaluate the incidence of acetylsalicylic acid (ASA) and clopidogrel resistance in patients with acute coronary syndrome with ST-segment elevation and to find out possible clinical factors, contributing to this state.

Material and methods. 58 patients with acute coronary syndrome with ST-segment elevation (49 men, 9 women) were included into the study. Age of patients ranged from 37 tо 84 y.o. (60,8±12,3 y.o. in average). Platelet aggregation was assessed by the Born’s method. Level of arachidonic acidinduced aggregation ≥20% considered as ASA resistance. Decreasing of ADP-induced platelet aggregation ≥20% considered as ASA resistance. Decreasing of ADP-induced platelet aggregation <10%, 10-29%, and ≥30% compared to the basal level considered as clopidogrel resistance, “partial clopidogrel resistance” or clopidogrel sensitiveness, respectively.

Results. ASA and clopidogrel decreased arachidonic acid-induced and ADP-induced aggregation after 7 days of the therapy compared to the basal levels (р<0,05). The highest incidence of resistance was registered in patients with diabetes mellitus (71,1% to ASA, 57,1% to clopidogrel) and obe-sity (42,9% to clopidogrel).

Conclusion. The incidence of ASA and clopidogrel resistance reached to 28,9% and 24,4% respectively in patients with acute coronary syndrome with ST-segment elevation. The prevalence of antiplatelet therapy resistance is significantly higher in patients with diabetes mellitus and obesity (р<0,05). The incidence of early complications of acute myocardial infarction is higher in patients resistant to ASA and clopidogrel.

About the Authors

D. H. Ainetdinova
Moscow Medical Academy named after I.M. Setchenov
Russian Federation
Department of faculty therapy №1


A. Е. Udovichenko
Moscow Medical Academy named after I.M. Setchenov
Russian Federation
Department of faculty therapy №1


V. A. Sulimov
Moscow Medical Academy named after I.M. Setchenov
Russian Federation
Department of faculty therapy №1


References

1. Antithrombotic Trialists' Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high-risk patients. BMJ 2002; 324:71–86.

2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17 187 cases of suspected acute myocardial infarction: ISIS-2. Lancet 1988; 2(8607):349–60.

3. CAPRIE Steering Committee. A randomized, blinded, trial of Clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lan- сet 1996; 348: 1329-39.

4. The Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N. Engl. J. Med. 2001; 345: 494-502.

5. Jarvis GE. Platelet aggregation: turbidimetric measurements. Methods Mol Biol. 2004;272:65-76.

6. Gum P.A., Kottke-Marchant K., Welsh P.A., et al. A prospective, blinded determination of the natural history of aspirin resistance among stable patients with cardiovascular disease. J Am Coll Cardiol. 2003; 41:961–5.

7. Muller I, Besta F, Schulz C. et al. Prevalence of clopidogrel non-responders among patients with stable angina pectoris scheduled for elective coronary stent placement. Thromb Haemost. 2003; 89: 783–7.

8. Eikelboom J.W., Hirsh J., Weitz J.I., et al. Aspirin-resistant thromboxane biosynthesis and the risk of myocardial infarction, stroke, or cardiovascular death in patients at high risk for cardiovascular events. Circulation 2002; 105: 1650–5.

9. Chen W.H., Lee P.Y., Ng W., et al. Aspirin resistance is associated with a high incidence of myonecrosis after non-urgent percutaneous coronary intervention despite clopidogrel pretreatment. J Am Coll Cardiol. 2004; 43: 1122–6.

10. Gurbel PA, Bliden KP, Hiatt BL, et al. Clopidogrel for coronary stenting: response variability, drug resistance, and the effect of pretreatment platelet reactivity. Circulation 2003; 107: 2908–13.

11. Hobikoglu GF, Norgaz T, Aksu H, et al. High frequency of aspirin resistance in patients with acute coronary syndrome. Tohoku J Exp Med. 2005; 207(1):59-64.

12. Matetzky S., Shenkman B., Guetta V., et al. Clopidogrel resistance is associated with increased risk of recurrent atherothrombotic events in patients with acute myocardial infarction. Circulation 2004; 109: 3171– 5.

13. Rasmanis G, Vesterqvist O, Green K, et al. Effects of intermittent treatment with aspirin on thromboxane and prostacyclin formation in patients with acute myocardial infarction. Lancet 1988, 2(8605):245- 7.

14. Angiolillo DJ, Fernandez-Ortiz A, Bernardo E, et al. Platelet Function Profiles in Patients With Type 2 Diabetes and Coronary Artery Disease on Combined Aspirin and Clopidogrel Treatment. Diabetes. 2005;54:2430-5.


For citation:


Ainetdinova D.H., Udovichenko A.Е., Sulimov V.A. ANTIPLATELET THERAPY RESISTANCE IN PATIENTS WITH ACUTE CORONARY SYNDROME WITH ST-SEGMENT ELEVATION. Rational Pharmacotherapy in Cardiology. 2008;4(2):23-29. (In Russ.) https://doi.org/10.20996/1819-6446-2008-4-2-23-29

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ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)