Thomson V S, John B, George P, Joseph G, Jose J
Department of Cardiology, Christian Medical College and Hospital, Vellore, India.
J Postgrad Med. 2009 Oct-Dec;55(4):252-6. doi: 10.4103/0022-3859.58927.
Aspirin resistance is a major problem and its incidence and clinical significance in Indian patients with documented coronary artery disease are not known.
We sought to study the incidence of aspirin resistance and its clinical significance in a cohort of Indian patients with coronary heart disease on therapy with aspirin using urinary 11-Dehydrothromboxane B2 levels as a surrogate marker for antiplatelet efficacy.
Non randomized single center prospective study in cohort of patients with stable cardiovascular disease on chronic aspirin therapy attending the cardiology outpatient clinic of a tertiary care hospital.
Urinary dehydrothromboxane levels were analyzed in a cohort of 63 patients with stable documented coronary artery disease and in 21 healthy volunteers. The cases were followed up prospectively for a median period of 36 (1-53) months. The clinical endpoint was a composite of acute coronary syndrome, stroke, revascularization and death.
Comparison of urinary dehydrothromboxane concentration values between various risk factors was done using Mann Whitney U test, a non parametric alternative of independent t test. All statistical analyses were done using SPSS 11.0 (Chicago, USA) software.
The median (range) absolute values of urinary11- dehydrothromboxane B2 levels for the healthy volunteers and cases were 440 (286-2050) pg/ml and 320 (72-2600) pg/ml (P=0.007). The corresponding normalized values were 87.3 (43-143) and 60.8 (16.7-943) ng/mmol of creatinine (P=0.131). Among the various vascular risk factors, patients who were overweight had higher absolute levels of 11- urinary dehydrothomboxane B2 levels (P=0.016). There were significantly more clinical events in patients with absolute urinary 11-dehydrothromboxane B2 levels in the upper two quartiles compared to the lower two quartiles (P=0.04).
The incidence of aspirin resistance in the cohort of patients with documented heart disease was 38.1%. Patients with elevated absolute urinary dehydrothomboxane levels (>320 pg/ml) on chronic aspirin therapy constitute a high risk subset for recurrent vascular events.
阿司匹林抵抗是一个主要问题，其在有冠状动脉疾病记录的印度患者中的发生率及临床意义尚不清楚。
我们试图研究在一组接受阿司匹林治疗的印度冠心病患者中阿司匹林抵抗的发生率及其临床意义，使用尿11-脱氢血栓素B2水平作为抗血小板疗效的替代标志物。
在一家三级护理医院心脏科门诊对接受慢性阿司匹林治疗的稳定心血管疾病患者队列进行非随机单中心前瞻性研究。
对63例有稳定冠状动脉疾病记录的患者和21名健康志愿者的尿脱氢血栓素水平进行分析。对病例进行前瞻性随访，中位随访时间为36（1 - 53）个月。临床终点为急性冠状动脉综合征、中风、血运重建和死亡的复合终点。
使用曼 - 惠特尼U检验（独立t检验的非参数替代方法）比较不同危险因素之间的尿脱氢血栓素浓度值。所有统计分析均使用SPSS 11.0（美国芝加哥）软件进行。
健康志愿者和病例的尿11-脱氢血栓素B2水平的中位（范围）绝对值分别为440（286 - 2050）pg/ml和320（72 - 2600）pg/ml（P = 0.007）。相应的标准化值分别为87.3（43 - 143）和60.8（16.7 - 943）ng/mmol肌酐（P = 0.131）。在各种血管危险因素中，超重患者的尿11-脱氢血栓素B2绝对值水平较高（P = 0.016）。与尿11-脱氢血栓素B2绝对值水平处于下两个四分位数的患者相比，处于上两个四分位数的患者发生临床事件的比例显著更高（P = 0.04）。
有心脏病记录的患者队列中阿司匹林抵抗的发生率为38.1%。慢性阿司匹林治疗中尿脱氢血栓素水平绝对值升高（>320 pg/ml）的患者构成复发性血管事件的高风险亚组。
