ACETYLSALICYLIC ACID RESISTANCE IN PATIENTS WITH ACUTE CORONARY SYNDROME AND ITS RELATIONSHIP BETWEEN MEAN PLATELET VOLUME

Yıl 2025, Cilt: 27 Sayı: 1, 63 - 67, 26.04.2025

Mustafa Uçar , Ali Yaşar Kılınç , İbrahim Başarıcı , Fulya Avcı Demır , Sebahat Özdem

https://doi.org/10.24938/kutfd.1599043

Öz

Objective: Insufficient biochemical response to Acetylsalicylic Acid (ASA) is defined as 'ASA resistance'. Its prevalence is unknown. The frequency of death and cardiovascular events rises as the mean platelet volume (MPV) increases in patients with acute coronary syndrome (ACS). Patients with high MPV are more resistant to antiplatelet agents. Our study aimed to evaluate the temporal variability of ASA resistance and platelet reactivity in ACS patients and to demonstrate its relationship with MPV.
Material and Methods: Our study is single-center prospective, cross-sectional study. Patients over 18 years of age who were hospitalized due to ACS and underwent percutaneous coronary intervention were included. ASA resistance and MPV measurements were taken at admission and first month. The prevalence and alteration of ASA resistance and its relationship with MPV were analyzed.
Results: 115 patients were included in the study. 7 patients (6.08%) were ASA-resistant at first admission and increased to 22 (19.13%) at the 1st month follow-up (p=0.003). A significant numerical increase in ASA resistance was observed in the first month of controls (p<0.01). The prevalence of ASA resistance was calculated as 22.6%. MPV was found to be high in 16 patients (13.9%) at the time of admission, while it was found to be high in 15 patients (13.04%) at the 1-month follow-up (p=0.98). MPV values were found to be similar in patients with and without ASA resistance.
Conclusion: ASA resistance is more common than thought. Therefore, evaluating platelet functions in predicting the clinical outcomes of patients is important in determining the effectiveness of the antiplatelet agent used.

Anahtar Kelimeler

Acute coronary syndrome , acetylsalicylic acid , mean platelet volume

Akut Koroner Sendrom Hastalarında Asetilsalisilik Asit Direnci ve Ortalama Platelet Hacmi ile İlişkisi

Öz

Amaç: Asetilsalisilik asite (ASA) yetersiz biyokimyasal yanıt 'ASA direnci' olarak tanımlanır. Yaygınlığı bilinmemektedir. Akut koroner sendrom (AKS) hastalarında ortalama trombosit hacmi (OTH) arttıkça mortalite ve kardiyovasküler olayların sıklığı artar. Yüksek OTH’li hastalar antiplatelet ajanlara daha dirençlidir. Çalışmamız AKS hastalarında ASA direnci ve trombosit reaktivitesinin zamansal değişkenliğini değerlendirmeyi ve OTH ile ilişkisini göstermeyi amaçlamıştır.
Gereç ve Yöntemler: Çalışmamız tek merkezli prospektif, kesitsel bir çalışmadır. AKS nedeniyle hastaneye yatırılan ve perkütan koroner girişim uygulanan 18 yaş üstü hastalar çalışmaya dahil edildi. ASA direnci ve OTH ölçümleri başvuruda ve birinci ayda alındı. ASA direncinin yaygınlığı ve değişimi, OTH ile ilişkisi analiz edildi.
Bulgular: Çalışmaya 115 hasta dâhil edildi. İlk başvuruda 7 hasta (%6,08) ASA dirençliydi ve 1. ay kontrolünde bu sayı 22'ye (%19,13) yükseldi (p=0,003). 1. ay kontrollerinde ASA direncindeki sayısal artış anlamlı bulundu (p<0,01). ASA direnci prevalansı %22,6 olarak hesaplandı. Başvuru anında MPV 16 hastada (%13,9) yüksek bulunurken, 1. ay kontrolünde 15 hastada (%13,04) yüksek bulundu (p=0,98). ASA direnci olan ve olmayan hastalarda MPV değerlerinin benzer olduğu görüldü.
Sonuç: ASA direnci düşünüldüğünden daha yaygındır. Bu nedenle, trombosit işlevlerini değerlendirmek hastaların klinik sonuçlarını tahmin etmede, kullanılan antiplatelet ajanın etkinliğini belirlemede önemlidir.

Anahtar Kelimeler

Akut koroner sendrom , asetilsalisilik asit , ortalama platelet hacmi

Kaynakça

• Global Burden of Disease Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: A systematic analysis for the global burden of disease study 2019. Lancet. 2020;396:1204-1242.
• Mannu GS, Macartney A, Lambert JR, et al. The clinical utility of multiplate analyser measurement in platelet function testing following stroke and transient ischemic attack. Eur J Haematol. 2015;94:138-144.
• Karabulut D, Kaya A, Abacı O, Karabulut U, Turhan Çağlar FN, Arat Özkan A. The frequency of aspirin and clopidogrel resistance and related factors in patients undergoing elective percutaneous coronary intervention. EJCM. 2021;9(2):94-104.
• Antithrombotic Trialists' Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002;324:71-86.
• Bhatt DL. Aspirin resistance: More than just a laboratory curiosity. J Am Coll Cardiol. 2004;43:1127-1129.
• Maree AO, Fitzgerald DJ. Variable platelet response to aspirin and clopidogrelin atherothrombotic disease. Circ. 2007;115:2196-2207.
• Hovens MM, Snoep JD, Eikenboom JC, van der Bom JG, Mertens BJ, Huisman MV. Prevalence of persistent platelet reactivity despite use of aspirin: A systematic review. Am Heart J. 2007;153:175-181.
• Chu SG, Becker RC, Berger PB, et al. Mean platelet volume as a predictor of cardiovascular risk: A systematic review and meta-analysis. J Thromb Haemost. 2010;8:148-156.
• Davi PG. Platelet activation and atherothrombosis. N Engl J Med. 2007;357:2482-2494.
• Senaran H, Ileri M, Altinbaş A, et al. Thrombopoietin and mean platelet volume in coronary artery disease. Clin Cardiol. 2001;24:405-408.
• Petreñas LC., Yubero, CG. Resistance to aspirin: Prevalence, mechanisms of action and association with thromboembolic events. A narrative review. Farm Hosp.2010;34(1):32-43.
• Shah B, Oberweis B, Tummala L, et al. Mean platelet volume and long-term mortality in patients undergoing percutaneous coronary intervention. Am J Cardiol. 2013;111(2):185-189.
• Navarta DC, Trejo G, Lenonardi M, et al. Association between mean platelet volume and resistance to aspirin and P2Y12 receptor inhibitors in elderly patients with acute coronary syndrome. Rev Argent Cardiol. 2019;87:258-264.
• Khan H, Kanny O, Syed MH, Qadura M. Aspirin resistance in vascular disease: A review highlighting the critical need for improved point-of-care testing and personalized therapy. Int J Mol Sci. 2022;26;23(19):11317.
• Aksu H, Ozer O, Unal H, et al. Significance of mean platelet volume on prognosis of patients with and without aspirin resistance in settings of non-ST-segment elevated acute coronary syndromes. Blood Coagul Fibrinolysis. 2009;20(8):686-693.
• Tasdemir E, Toptas T, Demir C, Esen R, Atmaca M. Aspirin resistance in patients with type II diabetes mellitus. Ups J Med Sci. 2014;119(1):25-31.
• Gum PA, Kottke-Marchant K, Welsh PA, White J, Topol EJ. A prospective, blinded determination of the natural history of aspirin resistance among stable patients with cardiovascular disease. JACC. 2003;41:961-965.
• Castilla-Guerra L, Navas-Alcántara MS, Fernández- Moreno MC. Aspirin resistant patients with recent ischemic stroke. Rev Clin Esp (Barc). 2014;214(3):145- 149.
• Han YL. Aspirin resistance in coronary heart disease: Current understandings and strategies. J Transl Int Med. 2016;4(1):7-10.