用 ω-3 脂肪酸治疗阿司匹林抵抗患者与增加阿司匹林剂量。

Treatment of aspirin-resistant patients with omega-3 fatty acids versus aspirin dose escalation.

机构信息

Cardiology Department, Rabin Medical Center, Petah Tikva, Israel.

出版信息

J Am Coll Cardiol. 2010 Jan 12;55(2):114-21. doi: 10.1016/j.jacc.2009.08.039.

DOI:10.1016/j.jacc.2009.08.039

PMID:20117379

Abstract

OBJECTIVES

The aim of this study was to evaluate whether addition of omega-3 fatty acids or increase in aspirin dose improves response to low-dose aspirin among patients who are aspirin resistant.

BACKGROUND

Low response to aspirin has been associated with adverse cardiovascular events. However, there is no established therapeutic approach to overcome aspirin resistance. Omega-3 fatty acids decrease the availability of platelet arachidonic acid (AA) and indirectly thromboxane A2 formation.

METHODS

Patients (n = 485) with stable coronary artery disease taking low-dose aspirin (75 to 162 mg) for at least 1 week were screened for aspirin response with the VerifyNow Aspirin assay (Accumetrics, San Diego, California). Further testing was performed by platelet aggregation. Aspirin resistance was defined by > or =2 of 3 criteria: VerifyNow score > or =550, 0.5-mg/ml AA-induced aggregation > or =20%, and 10-micromol/l adenosine diphosphate (ADP)-induced aggregation > or =70%. Thirty patients (6.2%) were found to be aspirin resistant and randomized to receive either low-dose aspirin + omega-3 fatty acids (4 capsules daily) or aspirin 325 mg daily. After 30 days of treatment patients were re-tested.

RESULTS

Both groups (n = 15 each) had similar clinical characteristics. After treatment significant reductions in AA- and ADP-induced aggregation and the VerifyNow score were observed in both groups. Plasma levels of thromboxane B2 were also reduced in both groups (56.8% reduction in the omega-3 fatty acids group, and 39.6% decrease in the aspirin group). Twelve patients (80%) who received omega-3 fatty acids and 11 patients (73%) who received aspirin 325 mg were no longer aspirin resistant after treatment.

CONCLUSIONS

Treatment of aspirin-resistant patients by adding omega-3 fatty acids or increasing the aspirin dose seems to improve response to aspirin and effectively reduces platelet reactivity.

摘要

目的

本研究旨在评估在阿司匹林抵抗患者中添加 ω-3 脂肪酸或增加阿司匹林剂量是否能改善低剂量阿司匹林的反应。

背景

低剂量阿司匹林反应不佳与不良心血管事件相关。然而，目前尚无克服阿司匹林抵抗的既定治疗方法。ω-3 脂肪酸可减少血小板花生四烯酸（AA）的可用性，并间接抑制血栓素 A2 的形成。

方法

筛选出服用低剂量阿司匹林（75 至 162mg）至少 1 周的稳定型冠状动脉疾病患者（n=485），通过 VerifyNow 阿司匹林检测法（Accumetrics，圣地亚哥，加利福尼亚州）检测阿司匹林反应。通过血小板聚集进一步进行检测。阿司匹林抵抗定义为满足以下 3 个标准中的≥2 个：VerifyNow 评分≥550、0.5mg/ml AA 诱导的聚集≥20%，以及 10μmol/l 二磷酸腺苷（ADP）诱导的聚集≥70%。发现 30 例（6.2%）患者对阿司匹林抵抗，并随机分为低剂量阿司匹林+ω-3 脂肪酸（每日 4 粒）或阿司匹林 325mg 组。治疗 30 天后再次进行检测。

结果

两组（每组 15 例）具有相似的临床特征。治疗后，两组的 AA 和 ADP 诱导的聚集和 VerifyNow 评分均显著降低。两组的血栓素 B2 水平也降低（ω-3 脂肪酸组降低 56.8%，阿司匹林组降低 39.6%）。接受 ω-3 脂肪酸治疗的 12 例患者（80%）和接受阿司匹林 325mg 治疗的 11 例患者（73%）在治疗后不再对阿司匹林抵抗。