Department of Internal Medicine, Academic Medical Center, Amsterdam, the Netherlands.
J Thromb Haemost. 2012 Apr;10(4):639-46. doi: 10.1111/j.1538-7836.2012.04632.x.
Low-dose aspirin seems to offer no benefit in the primary prevention of cardiovascular disease in type 2 diabetes mellitus (DM2). The anti-platelet effect may be diminished by poor glycemic control or inadequate dosing of aspirin.
To study the effects of both glycemic control and increasing aspirin dose on platelet response to aspirin in DM2 patients and matched controls.
PATIENTS/METHODS: Platelet effects of increasing doses of aspirin (30, 100 and 300 mg daily) were prospectively assessed in 94 DM2 patients and 25 matched controls by measuring thromboxane levels in urine (11-dhTxB2) and platelet aggregation using VerifyNow(®) and light transmission aggregometry (LTA). DM2 patients were stratified for glycemic control (hemoglobin-A1c [HbA1c] ≤ 53, 53-69, ≥ 69 mmol mol(-1)).
At baseline, median 11-dhTxB2 excretion was higher in the poorly controlled patients (77 ng mmol(-1)), and the moderately controlled (84 ng mmol(-1)) compared with the well-controlled patients (64 ng mmol(-1)) and controls (53 ng mmol(-1)), P < 0.01. Next, 30 mg of aspirin reduced 11-dhTxB2 excretion to 31, 29 and 24 ng mmol(-1) in the poorly, moderately and well-controlled patients, respectively, and to 19 ng mmol(-1) in controls, P < 0.001. VerifyNow(®) and LTA were also incompletely suppressed in DM2 patients using 30 mg of aspirin, but 100 mg resulted in similar platelet suppression in all groups, with no additional effect of 300 mg.
DM2 patients with inadequate glycemic control (HbA1c > 53 mmol mol(-1)) have higher baseline platelet activity and incomplete suppression of platelet activity with 30 mg of aspirin. However, 100 mg of aspirin leads to optimal inhibition irrespective of glycemic control, and 300 mg does not further improve platelet suppression.
小剂量阿司匹林似乎不能预防 2 型糖尿病患者的心血管疾病。血小板的抗血小板作用可能会因血糖控制不佳或阿司匹林剂量不足而减弱。
研究血糖控制和增加阿司匹林剂量对 2 型糖尿病患者和匹配对照组血小板对阿司匹林反应的影响。
患者/方法：通过测量尿液中血栓素水平（11-脱氢血栓素 B2[11-dhTxB2]）和使用 VerifyNow（®）和光传输聚集法（LTA）测量血小板聚集，前瞻性评估 94 例 2 型糖尿病患者和 25 例匹配对照组中增加剂量阿司匹林（每天 30、100 和 300mg）的血小板效应。根据糖化血红蛋白（HbA1c）水平将 2 型糖尿病患者分层（≤53、53-69、≥69mmol/mol）。
基线时，血糖控制不佳的患者（77ngmmol-1）、血糖控制中度的患者（84ngmmol-1）的 11-dhTxB2 排泄中位数高于血糖控制良好的患者（64ngmmol-1）和对照组（53ngmmol-1），P<0.01。接下来，30mg 阿司匹林分别将血糖控制不佳、血糖控制中度和血糖控制良好的患者的 11-dhTxB2 排泄降低至 31、29 和 24ngmmol-1，对照组降低至 19ngmmol-1，P<0.001。在使用 30mg 阿司匹林时，2 型糖尿病患者的 VerifyNow（®）和 LTA 也不完全抑制，但 100mg 在所有组中产生相似的血小板抑制，而 300mg 没有额外的作用。
糖化血红蛋白（HbA1c）>53mmol/mol 的 2 型糖尿病患者基线血小板活性较高，且使用 30mg 阿司匹林时血小板活性抑制不完全。然而，100mg 阿司匹林可导致最佳抑制，与血糖控制无关，而 300mg 不会进一步改善血小板抑制。
