Cotter Gad, Shemesh Eyal, Zehavi Miriam, Dinur Irit, Rudnick Abraham, Milo Olga, Vered Zvi, Krakover Rikardo, Kaluski Edo, Kornberg Abraham
Clinical Pharmacological Research Unit, The Cardiology Institute, Zerifin, Israel.
Am Heart J. 2004 Feb;147(2):293-300. doi: 10.1016/j.ahj.2003.07.011.
A lack of aspirin effect on platelets after a myocardial infarction (MI) is associated with poor health outcome. This lack of effect may be due to biological resistance to aspirin or due to nonadherence (the patient is not taking the aspirin, hence it has no effect). Determining which of these factors predicts poor outcome would inform potential intervention strategies.
Aspirin effect on platelets was assessed in a cohort of MI survivors who were divided into three groups: group A ("adherent"), patients whose platelets were affected by aspirin; group B ("nonadherent"), patients whose platelets showed no aspirin effect and who admitted in an interview that they were not taking their medications; and group C (potentially biologically resistant to aspirin), patients whose platelets showed no aspirin effect but maintained that they were taking their aspirin. Two health outcome measures (death, reinfarction, or rehospitalization for unstable angina; or admission for any cardiovascular causes) were assessed 12 months after enrollment.
Seventy-three patients were enrolled and classified into groups A ("adherent," 52 patients), B ("nonadherent," 12 patients), and C ("potentially aspirin resistant," 9 patients). Adverse events and readmission were more common in the nonadherent group (B)-42% and 67%, respectively, when compared with the adherent group (A)-6% and 11%, and with the potentially biologically resistant group (C)-11% and 11%.
Nonadherence is a significant mediator of poor outcome. It is important to evaluate whether or not patients are taking their medications in clinical settings and in studies that evaluate the effect of prescribed medications.
心肌梗死（MI）后阿司匹林对血小板缺乏作用与不良健康结局相关。这种作用缺乏可能是由于对阿司匹林的生物学抵抗，或由于不依从（患者未服用阿司匹林，因此无作用）。确定这些因素中哪一个可预测不良结局将为潜在的干预策略提供依据。
在一组MI幸存者中评估阿司匹林对血小板的作用，这些幸存者被分为三组：A组（“依从”），血小板受阿司匹林影响的患者；B组（“不依从”），血小板未显示阿司匹林作用且在访谈中承认未服药的患者；C组（对阿司匹林可能有生物学抵抗），血小板未显示阿司匹林作用但坚称服用了阿司匹林的患者。在入组12个月后评估两项健康结局指标（死亡、再梗死或因不稳定型心绞痛再次住院；或因任何心血管原因入院）。
73例患者入组并分为A组（“依从”，52例患者）、B组（“不依从”，12例患者）和C组（“可能对阿司匹林抵抗”，9例患者）。与依从组（A组）的6%和11%以及可能有生物学抵抗组（C组）的11%和11%相比，不依从组（B组）的不良事件和再入院更为常见，分别为42%和67%。
不依从是不良结局的重要中介因素。在临床环境以及评估处方药效果的研究中，评估患者是否服药很重要。
