Koroner Arter Hastalığı Saptanan Hastalarda PFA-100 Sistemi ile Aspirin Direnci Sıklığının Araştırılması

Yıl 2014, Cilt: 15 Sayı: 1, 13 - 19, 01.04.2014

Emre Sarandöl Ali Aydınlar

Öz

Objective: Today aspirin is the most widely used antithrombotic drug. In this study frequency of the aspirin resistance (AR) was evaluated in coronary artery disease (CAD) patients with PFA-100 system. Material and Methods: In the study 97 patients that routinely used 100 mg or higher aspirin for four weeks and that had coronary angiographic examination were included. In the cases with PFA-100 system AR was determined. Results: When all the cases were examined for AR, it was more frequent in the cases with CAD. In the group with CAD, patients with AR more frequently smoked smoking and the LDL and Total Cholesterol/HDL cholesterol levels were significantly higher compared to the aspirin sensitive patients. When the cases with CAD were compared according to the aspirin dose they had (100mg ve 300mg) the two groups did not differ significantly. The patients with CAD were divided into three goups accordıng to the number of dıseased vessels. Group 1 was constituted of cases with one vessel disease (n=21, % 35), group 2 two vessel disease (n=16, % 26) and group 3 was constituted of patients with three vessel disease (n=23, % 38). There no was statistically significant difference in terms of AR among all three groups. Conclusion: As a result, it was shown that the responses were not the same in patients taking aspirin. It was concluded that in cases with CAD adequacy of aspirin response may be quickly evaluated by PFA-100 system and the therapy may be adjusted according to the results

Anahtar Kelimeler

Coronary artery disease; aspirin resistance; PFA100 system

Koroner Arter Hastalığı Saptanan Hastalarda PFA-100 Sistemi ile Aspirin Direnci Sıklığının Araştırılması

Öz

Amaç: antitrombotik ilaçtır. Çalışmamızda koroner arter hastalığı (KAH) saptanan olgularda PFA-100 sistemiyle aspirin direncinin (AD) sıklığı değerlendirildi. Gereç ve Yöntem: Çalışmamıza en az 4 hafta süre ile düzenli olarak, 100 mg ve daha fazla Aspirin kullanan koroner anjiyografisi yapılan 97 hasta dahil edildi. Hastalarda PFA-100 sistemi kullanılarak AD saptandı. Bulgular: Tüm olgularımız aspirine yanıt bakımından karşılaştırıldığında KAH saptananlarda, saptanmayanlara göre AD anlamlı derecede yüksek bulundu. KAH saptanan aspirine dirençli grupta, sigara içiciliği daha fazlaydı, LDL değerleri ve Total Kolesterol/HDL değerleri aspirine duyarlı gruba göre anlamlı derecede yüksekti. KAH saptananlarda AD olanlar kullandıkları aspirin dozu (100mg ve 300mg) açısından karşılaştırıldıklarında iki grup arasında istatistiksel açıdan anlamlı bir fark saptanmamıştır. KAH saptanan olgular tek damar hastalığı olanlar grup 1 (n=21, % 35), iki damar hastalığı olanlar grup 2 (n=16, % 26) ve üç damar hastalığı olanlar grup 3 (n=23, % 38) olmak üzere üç gruba ayrıldı. Üç hasta grubu AD açısından karşılaştırıldıklarında istatistiksel olarak anlamlı farklılık saptanmamıştır. Sonuç: Aspirin tedavisi alan hastalarda cevabın benzer olmadığı gösterildi. KAH saptanan olgularda aspirin cevabının yeterliliğinin her hastada PFA-100 sistemi ile kısa sürede değerlendirilip tedavinin bu sonuçlara göre düzenlenebileceği kanaatine varıldı

Anahtar Kelimeler

Aspirin direnci; koroner arter hastalığı; PFA-100 sistemi

Kaynakça

• Bonow RO, Smaha LA, Smith SC Jr, Mensah GA, Lenfant C. World Heart Day 2002: the international burden of cardiovascular disease: responding to the emerging 2002;106(13):1602-5. epidemic. Circulation
• Hennekens CH, Dyken ML, Fuster V. Aspirin as a therapeutic agent in cardiovascular disease: a statement for healthcare professionals from the American 1997;96(8):2751-3. Association. Circulation
• Collins R, Baigent C, Sandercock P, Peto R. Antiplatelet therapy for thromboprophylaxis: the need for careful consideration of the evidence from randomised trials. Antiplatelet Trialists’ Collaboration BMJ 1994;309(6963):1215-7.
• Antithrombotic Trialists’ (ATT) Collaboration, Baigent C, Blackwell L, Collins R, et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data randomised 2009;373(9678):1849-60. trials. Lancet
• Secondary prevention of vascular disease by prolonged Trialists’ Collaboration. Br Med J (Clin Res Ed) 1988;296(6618):320-31. treatment. Antiplatelet
• Lordkipanidzé M, Pharand C, Schampaert E, Turgeon J, Palisaitis DA, Diodati JG. A comparison of six major platelet function tests to determine the prevalence of aspirin resistance in patients with stable coronary artery disease. Eur Heart J 2007;28(14):1702
• Michelson AD, Cattaneo, M, Eikelboom JW, et al. Aspirin resistance: position paper of the Working Group on Aspirin Resistance. J Thromb Haemost 2005;3(6):1309-11.
• Koroner Arter Hastalığıda Aspirin Direnci Aspirin Resistance in Coronary Artery Disease Michos ED, Ardehali R, Blumenthal RS, Lange RA, Ardehali H. Aspirin and clopidogrel resistance. Mayo Clin Proc 2006;81(4):518-26
• Mammen EF, Alshameeri RS, Comp PC. Preliminary data from a field trial of the PFA-100 system. Semin Thromb Hemost 1995;21(Suppl 2):113-21.
• Pamukçu B, Onür I, Oflaz H, Elitok A, Buğra Z, Nişanci Y. The relationship between aspirin resistance and endothelial dysfunction in patients with stable coronary artery disease. Arch Turk Soc Cardiol 2008;36(2):103-7.
• Pamukcu B. A review of aspirin resistance; definition, possible mechanisms, detection with platelet function tests, and its clinical outcomes. J Thromb Thrombolysis 2007;23(3):213-22.
• Gum PA, Kottke-Marchant K, Poggio ED, et al. Profile and prevalence of aspirin resistance in patients with 2001;88(3):230-5. disease. Am J Cardiol
• Pamukcu B, Oflaz H, Nisanci Y. The role of platelet glycoprotein IIIa polymorphism in the high prevalence of in vitro aspirin resistance in patients with intracoronary 2005;149(4):675-80. Am Heart J
• Macchi L, Christiaens L, Brabant S, et al. Resistance to aspirin in vitro is associated with increased platelet sensitivity to adenosine diphosphate. Thromb Res 2002; 107(1-2):45-9.
• Coma-Canella I, Velasco A, Castano S. Prevalence of aspirin resistance measured by PFA-100. Int J of Cardiol 2005;101(1):71-6.
• Helgason CM, Bolin KM, Hoff JA, et al. Development of aspirin resistance in persons with previous ischemic stroke. Stroke 1994;25(12):2331-6.
• Hung J, Lam JY, Lacoste L, Letchacovski G. Cigarette smoking acutely increases platelet thrombus formation in patients with coronary artery disease taking aspirin. Circulation 1995;92(9):2432-6.
• Undas A, Brummel KE, Musial J, Mann KG, Szczeklik A. Simvastatin depresses blood clotting by inhibiting activation of prothrombin, factor V, and factor XIII and by enhancing factor Va inactivation. Circulation 2001;130(18):2248-53.
• Andersen K, Hurlen M, Arnesen H, Seljeflot I. Aspi- rin non-responsiveness as measured by PFA-100 in patients with coronary artery disease. Thromb Res 2003;108(1):37-42.
• Buchanan MR, Brister SJ. Individual variation in the effects of ASA on platelet function: implications for the use of ASA clinically. Can J Cardiol 1995;11(3):221
• Szczeklik A, Musial J, Undas A. Reasons for re- sistance to aspirin in cardiovasculer disease. Circula- tion 2002;106(22):181-2.
• Friend M, Vucenik I, Miller M. Platelet responsive- ness to aspirin in patientswith hyperlipidemia. BMJ 2003;326(7380):82-3.
• Trowbridge EA, Martin JF. The platelet volume distribution:a signature of the prethrombotic state in coronary 1987;58(2):714-7. disease. heart Thromb Haemost
• Schafer Al. Genetic and acquired determinants of individual variability of response to antiplatelet drugs. Circulation 2003;108(8):910-1.