血管外科中 ASA 无反应的术前和术后患病率及危险因素。

The Pre- and Postoperative Prevalence and Risk Factors of ASA Nonresponse in Vascular Surgery.

机构信息

Sana Klinikum Offenbach, Medical Clinic I, 9206Internal Intensive Care Medicine and General Medicine, Offenbach, Germany.

39482Asklepios Klinik Wandsbek, Intensive Care Medicine and Emergency Medicine, Hamburg, Germany.

出版信息

Clin Appl Thromb Hemost. 2021 Jan-Dec;27:10760296211044723. doi: 10.1177/10760296211044723.

DOI:10.1177/10760296211044723

PMID:34609920

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8642110/

Abstract

BACKGROUND

An antiplatelet therapy with acetylsalicylic acid (ASA) is prescribed in the prevention of cardiovascular events, but around 24% of ASA takers are resistant to the treatment.

AIM

In this prospective, observational cohort study, we aimed to identify the prevalence and risk factors of ASA nonresponse in patients who underwent vascular surgery.

METHODS

The study was conducted in the University hospital in Frankfurt am Main. In total, 70 patients were pre-treated with 100 mg of ASA per day and underwent either elective carotid thromboendarterectomy, femoral thromboendarterectomy or endovascular aneurysm repair of the abdominal aorta. The platelet function was measured on the first preoperative and the second or fourth postoperative day with the multiple electrode aggregometry by in-vitro stimulation with arachidonic acid (ASPItest) and thrombin receptor activating peptide 6 (TRAPtest). The primary end point was the in-vitro induced platelet aggregation in the ASPItest. If the ASPItest amounted ≥400 AU × min, the patients were categorized as ASA nonresponders.

RESULTS

The total prevalence of ASA nonresponse in our study was 20% preoperatively and 35.7% postoperatively (p = 0.005). As significant predictors for ASA nonresponse, we demonstrated the area under the aggregation curve in the TRAPtest preoperatively (p = 0.04) and postoperatively (p = 0.02), and the two comorbidities arterial hypertension ( < .001; rho 0.44) and diabetes mellitus (p = 0.04; rho 0.39), which are already well known to be associated with ASA nonresponse.

CONCLUSION

In conclusion, data of the study indicate a high incidence of perioperative, laboratory ASA nonresponse in patients undergoing vascular surgery.

摘要

背景

阿司匹林（ASA）抗血小板治疗被用于预防心血管事件，但约 24%的 ASA 使用者对治疗有抵抗。

目的

在这项前瞻性观察队列研究中，我们旨在确定接受血管手术的患者中 ASA 无反应的发生率和危险因素。

方法

该研究在法兰克福大学医院进行。总共 70 名患者每天接受 100mg 的 ASA 预处理，并接受择期颈动脉血栓内膜切除术、股动脉血栓内膜切除术或腹主动脉血管内动脉瘤修复术。在术前第 1 天和术后第 2 天或第 4 天，通过体外刺激花生四烯酸（ASPItest）和血栓素受体激活肽 6（TRAPtest）用多电极聚集仪测量血小板功能。主要终点是 ASPItest 中体外诱导的血小板聚集。如果 ASPItest 达到≥400AU×min，则将患者归类为 ASA 无反应者。

结果

我们的研究中术前 ASA 无反应的总发生率为 20%，术后为 35.7%（p=0.005）。作为 ASA 无反应的显著预测因素，我们在术前（p=0.04）和术后（p=0.02）的 TRAPtest 中显示聚集曲线下面积，以及两种合并症动脉高血压（ < 0.001；rho 0.44）和糖尿病（p=0.04；rho 0.39），这些因素已经被证明与 ASA 无反应有关。