Authors
1 Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan, Iran
2 Isfahan University of Medical Sciences, Isfahan, Iran
3 Department of Cardiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
4 Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Coronary artery disease (CAD) and myocardial infarction are the most common causes of mortality and morbidity all over the world. Aspirin resistance is an important part of therapeutic failure in patients who experience several atherosclerotic events despite aspirin therapy. Different studies have reported aspirin resistance between 5% and 45% all over the world.
According to different responses to aspirin therapy in countries and lack of adequate studies on aspirin resistance in Iran, this study was designed for evaluation of aspirin resistance in ischemic patients.
Materials and Methods: Total 170 patients with documented coronary artery stenosis with were enrolled in this cross-sectional prospective study. Two cc urine samples were obtained from all the subjects. Then a questionnaire including questions about major risk factors (hypertension, diabetes, hyperlipidemia, obesity and smoking) was completed for each patient. Thromboxane B2 level in urine was measured two times for each patient by one kit of via ELISA method. Gensini modified was usedfor assessment of severity of coronary arteries involvement. Data were analyzed via SPSS 16. with general linear model (univariate).
Results: 75.3% of studied patients were aspirin resistant. There was significant relationship between angiography score and aspirin resistance (P<0.001).Our results also showed that aspirin resistance is more common in studied women than men (P=0.003).Significant correlation was observed between diabetes and aspirin resistance in studied subjects (P=0.023).
Conclusion: Our study showed aspirin resistance in a sample of Iranian ischemic patients is so prevalent which is higher than other studies in another communities and also aspirin resistance is more common in patients with severe CAD.
Keywords
1. | Collaborative overview of randomized trials of antiplatelet therapy-I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Antiplatelet Trialists' Collaboration. BMJ1994;308:81-106. |
2. | Collaborative meta-analysis of randomized trials of antiplateler therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002;324:71-86. |
3. | Vane JR, Bakhlle YS, Botting RM. Cyclooxygenaz 1 and 2. Annu Rev Pharmacol Toxicol 1998;38:97-120. |
4. | Catella-Lawson F, Reilly MP, Kapoor SC, Cucchiara AJ, DeMarco S, Tournier B, et al. Cyclooxygenase inhibitors and the antiplatelet effects of aspirin. N Engl I Med 2001;345:1809-17. [PUBMED] |
5. | Vane JR, Bakhle YS, Botting RM. Cyclooxygenases 1 and 2. Annu Rev Pharmacol Toxicol1998;38:97-120. [PUBMED] |
6. | Hankey GJ, Eikelboom JW. Aspirin resistance BMJ 2004;328:477-9. |
7. | Weber AA, Przytulski B, Schanz A, Hohlfeld T, Schror K. Towards a definition of aspirin resistance: A typological approach. Platelets2002;13:37-40. |
8. | Smout J, Stansby G. Aspirin resistance. Br J Surg 2002;89:4-5. [PUBMED] |
9. | Tarjan J, Salamon A, Jager R, Poor F, Barczi V, Dinnyes J, et al. [The rate of acetylsalicylic acid non-respondents among patients hospitalized for acute coronary disease, previously undergoing secondary salicylic acid prophylaxis]. Orv Hetil 1999;140:2339-43. |
10. | Patrono C, Coller B, Dalen JE, FitzGerald GA, Fuster V, Gent M, et al. platelet-active drugs: The relationships among dose, effectiveness, and side effects. Chest2001;119:39S-63S. [PUBMED] |
11. | Halushka MK, Walker LP, Halushka PV. Genetic variation in cyclooxygenase 1: Effects on response to aspirin. Clin Pharmacol Ther 2003;73:122-30. [PUBMED] |
12. | Kasotakis G, Pipinos II, Lynch TG. Current evidence and clinical implications of aspirin resistance. J Vasc Surg 2009;50:1500-10. [PUBMED] |
13. | Kim H, Lee HK, Han K, Jeon HK. Prevalence and risk factors for aspirin and clopidogrel resistance in patients with coronary artery disease or ischemic cerebrovascular disease. Ann Clin Lab Sci 2009;39:289-94. [PUBMED] |
14. | Shen H, Herzog W, Drolet M, Pakyz R, Newcomer S, Sack P,et al. Aspirin Resistance in healthy drug-naive men versus women (from the Heredity and Phenotype Intervention Heart Study). Am J Cardiol 2009;104:606-12. [PUBMED] |
15. | Pinto Slottow TL, Bonello L, Gavini R, Beauzile P, Sushinsky SJ, Scheinowitz M,et al. Prevalence of aspirin and clopidogrel resistance among patients with and without drug-eluting stent thrombosis. Am J Cardiol 2009;104:525-30. [PUBMED] |
16. | Sanioglu S, Tetik S, Sokullu O, Deniz H, Aydemir N, Yilmaz M,et al. Aspirin resistance after CABG. Thorac Cardiovasc Surg 2009;57:281-5. |
17. | Acikel S, Yildirir A, Aydinalp A, Bal U, Kaynar G, Ozin B, et al. The clinical importance of laboratory-defined aspirin resistance in patients presenting with non-ST elevation acute coronary syndromes. Coagul Fibrinolysis 2009;20:427-32. [PUBMED] |
18. | Akhtar N, Junaid A, Khalid A, Ahmed W, Shah MA, Rahman H. Report: Frequency of aspirin resistance in patients with coronory artery disease in Pakistan. Pak J Pharm Sci 2009;22:230-3. [PUBMED] |
19. | Bruno A,McConnel JP,Mansbach HH,Cohen SN,Tietjen GE,Bang NU.Aspirin and urinary 11-dehydrothroboxaneB2 in African American stroke patients.Stroke 2002;33:57-60. |
20. | Sanderson S,Emery J,Baglin T,Kinmonth AL.Narrtaive Review:Aspirin resistance and its clinical implications.Ann Intren Med 2005;142:370-80. [PUBMED] |
21. | Sullivan DR,Marwick TH,Freedman SB.A new method of scoring coronary angiogram to reflect extent of coronary atherosclerosis and improve correlation with major risk factors AmHeartJ 1990;119:1262-6. |
22. | Sadeghi M, Roohafza HR, Kelishadi R. High Blood pressure and associated cardiovascular risk factors in Iran, IHHP. Med J Malaysia 2004; 59(4): 295-304. |
23. | Sadeghi M, Roohafza HR, Shirani SH, Poormoghadas M, Kelishadi R, Baghaie A. Diabetes and associated cardiovascular risk factors in Iran: Isfahan Healthy Heart Programms. Annals Academy of Medicine, Singapore 2007; 36: 175-80. |
24. | Sadeghi M, Roohafza HR. Serum lipid distribution and prevalence of dyslipidemia in urban and rural communities in Iran, IHHP. Pakistan Journal of Cardiology 2004; 14 (2):88-95. |
25. | Roohafza H, Shahnam M, Zolfaghari B, Toloei HR, Tavassoli A, Sadeghi M, et al. Stress level and smoking status in central Iran: Isfahan Healthy Heart Program. ARYA Atherosclerosis Journal 2011, 6(4): 144-148. |
26. | Peterson P. Aspirin resistance: Fact and Fiction. Medscape 2005; 12-20. |
27. | Siavash M, Sadeghi M, Salarifar F, Amini M, Shojaee-Mporadie F. Comparison of body mass index and waist/height ratio in predicting definite coronary artery disease. Ann Nutr Metab 2008;53(3):162-6. |
28. | Gasparyan AY, Watson T, Lip GY. The role of aspirin in cardiovascular prevention: Implications of aspirin resistance. J Am Coll Cardiol 2008;51:1829-43. [PUBMED] |
29. | Christiaens L, Ragot S, Mergy J, Allal J, Macchi L.Major clinical vascular events and aspirin-resistance status as determined by the PFA-100 method among patients with stable coronary artery disease: A prospective study.Blood Coagol Fibrinolysis2008;19:235-9. [PUBMED] |
30. | Akay OM, Canturk Z, Akin E, Bal C, Gulbas Z. Aspirin resistance frequency: A prospective study in 280 healthy Turkish volunteers. Clin Appl Thromb Hemost2009;15:98-102. [PUBMED] |
31. | Singla MK, Lahiri P, Mukhopadhyay P, Pandit K, Chaudhuri U, Chowdhury S. A study of aspirin resistance in type 2 diabetes. J Indian Med Assoc 2008;106:722-3. [PUBMED] |
32. | Zimmermann N, Hohlfeld T. Clinical implications of aspirin resistance. Thromb Haemost 2008;100:379-90. [PUBMED] |
33. | Sanderson S,Emery J,Baglin T,Kinmonth AL.Narrtaive Review:Aspirin resistance and its clinical implications.Ann Intren Med 2005;142:370-80. [PUBMED] |
34. | Durmaz T, Keles T, Ozdemir O, Bayram NA, Akcay M, Yeter E, et al. Heart rate variability in patients with stable coronary artery disease and aspirin resistance. Int Heart J 2008;49:413-22. [PUBMED] |
35. | Eskandarian R, Darabian M, Heshmatnia J, Ghorbani R. Acetyl salicylic acid resistance in patients with chronic stable angina and the correlation with coronary risk factors. Saudi Med J 2012;33:39-43.1 [PUBMED] |