Chair and Department of Cardiology, Medical University of Lodz, Lodz, Poland.
Kardiol Pol. 2013;71(12):1229-36. doi: 10.5603/KP.2013.0323.
There is no established management of resistance to acetylsalicylic acid (ASA) in patients with coronary artery disease (CAD). We hypothesised that simply doubling the usual daily dose of ASA could be effective in overcoming ASA resistance.
Our study comprised 40 subjects with CAD (male 67.5%, mean age 60.5 ± 8.8 years, mean body mass index 26.9 ± 2.7 kg/m² and median aspirin reaction unit [ARU] value obtained with a Verify Now Aspirin Test 612 [573-634]) with resistance to 75 mg/daily ASA defined as ARU ≥ 550. According to the overcoming of resistance or lack there of in a repeated test after four weeks of 150 mg daily ASA treatment, we defined two subsets: subjects who regained ASA sensitivity, and those who did not.
Successful overcoming of ASA resistance was observed in 62.5% of patients. Multivariate analysis regression confirmed that two variables independently determined successful ASA resistance suppression: male gender (OR 6.88; 95% CI 1.29-36.75; p = 0.024), and ARU for 75 mg daily (OR 0.97 per unit at 75 mg; 95% CI 0.94-0.99; p = 0.039). ROC analysis indicated that the threshold value at which ARU at 75 mg ASA treatment was predictive of successful ASA resistance overcoming was ≤ 608 ARU. Using a simple point score (one point for male gender and one for initial ARU ≤ 608), we found that ASA resistance was overcome in 8%, 36% and 56% of patients, when zero, any single, or two predictors were present.
ASA resistance overcoming by dose doubling can be achieved more often in males and in subjects with lower ARU value at ASA 75 mg.
在患有冠状动脉疾病 (CAD) 的患者中，尚无针对乙酰水杨酸 (ASA) 耐药的既定治疗方法。我们假设，简单地将 ASA 的常用日剂量增加一倍可能有助于克服 ASA 耐药性。
我们的研究包括 40 名 CAD 患者（男性占 67.5%，平均年龄 60.5±8.8 岁，平均体重指数 26.9±2.7kg/m²，用 Verify Now Aspirin Test 检测获得的中位阿司匹林反应单位 [ARU] 值为 612[573-634]），定义每日 75mg ASA 治疗耐药性的标准为 ARU≥550。根据在每日 150mg ASA 治疗 4 周后重复试验中是否克服耐药性或缺乏耐药性，我们将患者分为两组：恢复 ASA 敏感性的患者和未恢复的患者。
62.5%的患者成功克服了 ASA 耐药性。多变量分析回归证实，有两个变量独立确定了成功抑制 ASA 耐药性：男性（比值比 6.88；95%置信区间 1.29-36.75；p=0.024）和每日 75mg 的 ARU（每单位增加 75mg 时的比值比为 0.97；95%置信区间 0.94-0.99；p=0.039）。ROC 分析表明，75mg ASA 治疗时 ARU 的阈值预测成功克服 ASA 耐药性的标准为≤608ARU。使用简单的评分系统（男性为 1 分，初始 ARU≤608 为 1 分），我们发现当存在 0、1 或 2 个预测因子时，患者中分别有 8%、36%和 56%成功克服了 ASA 耐药性。
在男性和 ARU 值较低的患者中，通过增加剂量两倍可更常克服 ASA 耐药性。
