Application and monitoring of antiplatelet drugs in children with Kawasaki disease / 国际儿科学杂志

Long-term antiplatelet therapy is critical for children with Kawasaki disease.Commonly used antiplatelet drugs have their own advantages and adverse reactions, so they need to be chosen carefully.Some studies have shown that drug resistance may occur in children with Kawasaki disease during antiplatelet therapy, which increases the risk of cardiovascular adverse events, and platelet aggregation function needs to be monitored during medication.This paper reviews the antiplatelet drugs in common use, the drug resistance of antiplatelet drugs and the detection methods of platelet aggregation function in Kawasaki disease, which is helpful to improve the safety of drugs use and reduce the incidence of complications in children.

A young patient with recurrent myocardial infarction within a half month / 中南大学学报(医学版)

In this study, we reported a young male patient with acute chest pain who was diagnosed as myocardial infarction. The regular medication was performed following coronary intervention. Under such condition, this patient had 3 times myocardial infarction within a half month. The laboratory results showed that there might be a state of hypercoagulability. Aspirin combined with clopidogrel and other treatment were administrated. Meanwhile, the examination demonstrated that there was aspirin-resistant in the patient. The antiplatelet drug and extended anticoagulation therapy were carried out. There was no further myocardial infarction, and no coronary arteries stenosis was found in the re-examination angiography. Aspirin resistance and hypercoagulability should be considered when patients occurred the repeated myocardial infarction after regular medication and coronary intervention. Replacement of the antiplatelet treatment or combination with anticoagulant therapy is necessary in similar patient to avoid the sever consequence.

Meta-analysis of the Effectiveness and Safety of Compound Danshen Dripping Pills in Improving Aspirin Resistance / 中国药房

OBJECTIVE：To systematically evaluate the effectiveness and safety of Compound danshen dripping pills in improving aspirin resistance ，and to provide evidence-based evidence for clinical drug use. METHODS ：Retrieved from CNKI ， VIP，Wanfang database ，CBM，PubMed，Embase，the Cochrane L ibrary，randomized controlled trials （RCTs）about Compound danshen dripping pills （trial group ）versus aspirin （control group ）were collected during the inception to Jun. 2020. After literature screening and data extraction ，bias risk assessment tool recommended by the Cochrane evaluation manual handbook 5.1.0 was used to evaluate the quality of the included literatures ，and Rev Man 5.3 software was used for Meta-analysis and publication bias analysis. RESULTS ：A total of 10 RCTs were included ，with a total of 800 patients. Meta-analysis showed that the platelet aggregation rate （PAR）induced by adenosine diphosphate （ADP）in trial group was significantly lower than that of control group [SMD ＝－2.63，95％CI（－3.56，－1.70），P＜0.000 01]. Results of sub-group analysis by treatment cycle showed that PAR induced by ADP in trial group after 2 weeks of treatment [SMD ＝－2.11，95％CI（－2.75，－1.46），P＜0.000 01]，4 weeks of treatment [SMD ＝－2.84，95％CI（－4.26，－1.41），P＜0.000 1] Δ 基金项目 ：国家重点研发计划中医药现代化研究重点专项 and 8 weeks of treatment [SMD ＝－2.63，95％CI（－3.21， （No.2019YFC1710000，No.2019YFC1710003）；国家中医药管理局中 － 2.04），P＜0.000 01] was significantly lower than control 医药循证能力建设项目（No.2019XZZX-XXG003）；河南省创新型科技 团队项目 group. PAR induced by arachidonic acid （AA）of trial group ＊硕士研究生 。研究方向：中西医结合心血管疾病的预防和治 was significantly lower than that of control group [SMD ＝ 疗。E-mail：guohongxin1214@163.com －2.44，95％CI（－3.64，－1.24），P＜0.000 1]. Results of # 通信作者：主任医师，教授，硕士生导师，博士。研究方向：中医 sub-group analysis by treatment cycle showed that PAR 药防治心血管疾病的临床和基础 。电话：0371-66233478。E-mail： induced by AA in trial group after 2 weeks of tre atment [SMD ＝ zhumingjun317@163.com －2.56，95％CI（－3.26，－1.85），P＜0.000 01]，4 weeks of 中国药房 2021年第32卷第6期 China Pharmacy 2021Vol. 32 No. 6 ·743· treatment of [SMD ＝－2.45，95％CI（－4.79，－0.10），P＝0.04]，8 weeks of treatment [SMD ＝－2.38，95％CI（－2.94，－1.82），P＜ 0.000 01] was significantly lower than control group. The decrease of ADP-induced PAR [SMD ＝2.24，95％CI（1.36，3.13），P＜ 0.000 01]，AA-induced PAR [SMD ＝2.42，95％CI（1.94，2.89），P＜0.000 01] and response rate [RR ＝8.56，95％CI（4.38，16.74）， P＜0.000 01] in trial group were significantly higher than control group ，while the incidence of ADR [RR ＝0.30，95％CI（0.15， 0.60），P＝0.000 6]，the incidence of ischemic events [RR ＝0.13，95％CI（0.07，0.27），P＜0.000 01]，CR and RF after treatment （P＜0.05）were significantly lower than control group. There was no statistical significant difference in the incidence of bleeding events between 2 groups [RR ＝0.78，95％ CI（0.34，1.78），P＝0.55]. The results of publication bias showed that there was less possibility of publication bias in this study. CONCLUSIONS ：Compound danshen dripping pills can effectively improve aspirin resistance and has good safety.

Effect of acupuncture for regulating spleen and stomach on aspirin resistance in patients with type 2 diabetes mellitus: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the effect of acupuncture for regulating spleen and stomach on aspirin resistance in patients with type 2 diabetes mellitus (T2DM) and explore the effect mechanism.@*METHODS@#A total of 68 T2DM patients complicated with aspirin resistance were randomized into an observation group and a control group, 34 cases in each one. On the base of the conventional treatment for diabetes, aspirin enteric-coated tablets were prescribed for oral administration, 100 mg each time, once daily in the control group. In the observation group, on the basis of the treatment as the control group, acupuncture was used for regulating spleen and stomach at Zhongwan (CV 12), Zusanli (ST 36), Yinlingquan (SP 9), Hegu (LI 4), etc., once daily. The treatment for 1 week was as one course and 4 courses of treatment were required totally in two groups. Before and After treatment, the indexes of platelet function (platelet aggregation rate [PAG] and salicylic acid concentration), the indexes of vascular endothelial function (6-keone prostaglandin F1α[6-keto-PGF1α], thromin B2 [TXB2] and cyclooxysynthase-2 [COX-2]), blood glucose (fasting plasma glucose [FPG], 2 h plasma glucose [2h PG] and glycosylated hemoglobin [HbA1c]), insulin resistance index (HOMA-IR), blood lipid indexes (total cholesterol [TC], triacylglycerol [TG], high-density lipoprotein cholesterol [HDL-C] and low-density lipoprotein cholesterol [LDL-C]) and the total score of TCM symptoms were observed in the patients of two groups. Clinical therapeutic effect and safety was compared in the patients between the two groups after treatment and the recurrence rate of cardiocerebrovascular events was followed up 6 months after treatment.@*RESULTS@#After treatment, PAG, salicylic acid concentration, TXB2, COX-2, FPG, 2h PG, HbA1c, HOMA-IR, LDL-C, TC, TG and the total scores of TCM symptoms were all reduced as compared with those before treatment in the two groups (@*CONCLUSION@#Acupuncture for regulating spleen and stomach combined with aspirin enteric-coated tablets relieve insulin resistance and reduces blood glucose and lipid as well as the recurrence rate of cardiocerebrovascular events in the patients with T2DM, which is probably related to the regulation of insulin resistance and the improvement of vascular endothelial function. This combined therapy achieves the better effect on aspirin resistance as compared with simple aspirin enteric-coated tablets.

Association between cyclooxygenase gene rs20417 polymorphism and aspirin resistance: a meta-analysis

@#Background: Although the association of single nucleotide polymorphisms (SNPs) of cyclooxygenase (COX) genes and the risk of aspirin resistance (AR) has been extensively studied, the results remain conflicting. The majority of studies have focused on the role of rs20417 (COX-2 -G765C) in AR. To derive a more comprehensive and accurate evaluation of this association, we performed a meta-analysis including the most recent studies. Methods: Relevant studies published up to October 2018 were identified by searching the PubMed, EMBASE, Web of Science, Cochrane, China Nation Knowledge Infrastructure Platform, Wanfang, and VIP databases, and by manual searching reference lists of the retrieved articles. Odds ratios (ORs) and 95% confidence intervals (CIs) were applied to assess the strength of associations. Sensitivity and subgroup analyses were performed to explore the stability of results and between-study heterogeneity, respectively. Results: A total of 18 studies on rs20417 were pooled into the meta-analysis. Rs20417 was found to be associated with an increased risk of AR (C vs. G: OR = 1.43, 95% CI = 1.10–1.86, p < 0.05; GC+CC vs. GG: OR = 1.54, 95% CI =1.15–2.05, p < 0.05). These associations were stronger in Chinese participants and in patients with ischemic stroke in subgroup analyses. Conclusion: The presence of rs20417 indicates an increased risk of AR, especially in Chinese participants and patients with ischemic stroke. This association could help to improve personalized medicine and initiate appropriate treatment as necessary. Further large-scale studies are warranted to confirm our findings.

Relationship between carotid intima-media thickness and aspirin resistance in patients with stable coronary artery disease / 西安交通大学学报(医学版)

Objective: To explore the relationship between carotid intima-media thickness (IMT) and aspirin resistance (AR) in patients with stable coronary artery disease (SCAD). Methods: A total of 316 SCAD patients were enrolled and divided into 3 groups according to IMT measured by carotid artery ultrasound: normal group (n=80), atherosclerosis group (n=102), and plaque group (n=134). Thrombelastogram instrument (TEG) was used to detect platelet aggregation rate (PAG) according to the level of PAG induced by adenosine diphosphate (ADP) to determination AR. The correlation between PAG level (ADP-PAG) and various factors was analyzed, and Logistic regression was used to analyze the risk factors for AR in SCAD patients. Results: The ADP-PAG level was higher in plaque group than in atherosclerosis group and normal group (59.12±11.44 vs. 53.34±10.78 vs. 49.58±11.62, P<0.01); the incidences of AR and aspirin semi-resistance were both higher than those in the other two groups. After adjustment for age and other factors, Logistic regression analysis showed that age (OR=4.08), female (OR=5.06), carotid atherosclerosis (OR=3.57) and carotid plaque (OR=6.35) were independent risk factors for predicting AR in SACD patients (P<0.05). ROC curve analysis revealed that the optimal cutoff of IMT to predict AR in SCAD patients was 1.95 mm, the sensitivity was 86.3%, the specificity was 62.9%, and the area under curve was 0.762 (95% CI: 0.670-0.853, P<0.01). Conclusion: Carotid atherosclerosis is closely related to aspirin resistance in patients with SCAD, and it is an independent risk factor for AR.

Effect of aspirin on anti-platelet aggregation function in children with Kawasaki disease / 中国实用儿科杂志

OBJECTIVE: To evaluate the anti-platelet aggregation function of aspirin in children with Kawasaki disease(KD).METHODS: The clinical data of KD patients who was admitted to Capital Institute of Pediatrics-Peking University Teaching Hospital from September 2016 to September 2018 was retrospectively analyzed. All the children were treated with aspirin routinely:high-dose(30-50)mg/（kg·d)in acute stage and low-dose aspirin(3-5)mg/（kg·d)in the recovery period. Then the light transmission aggregometry(LTA)was used to determine the platelet aggregation rate of different doses of aspirin in order to evaluate the anti-platelet aggregation function,and the risk factors of aspirin resistance(AR)were analyzed by statistical method. RESULTS:(1)The platelet aggregation rate(AA%)after treatment with high-dose and low-dose aspirin in children with KD was 30.3%(1.2%,7.1%)and 2.9%(1.5%,60.4%),respectively,and there was no significant difference in platelet inhibition between different doses of aspirin(P=0.174).(2)The incidence of AR was 9.75%(23/236)in the highdose aspirin group and 8.05%(19/236)in the low-dose aspirin group. There was no significant difference in the incidence of AR between the two groups(P=0.617).(3)In the 19 children with AR and 217 children with aspirin sensitivity(AS)in oral low-dose aspirin treatment group,the age,sex,coagulation,biochemistry and other related indexes did not significantly differ between the two groups. CONCLUSION: The antiplatelet aggregation function of aspirin in KD children is not related to the dosage. AR is present in the treatment of Kawasaki disease,and the incidence of aspirin resistance is not related to dosage.

Network pharmacology-based study on mechanisms of Danhong Injection in treatment of aspirin resistance / 中国中药杂志

This paper aims to discuss the potential targets,pathways and possible mechanisms of Danhong Injection in treatment of aspirin resistance by using network pharmacology concept and network analysis technique. Active ingredients and potential targets of Danhong Injection were collected from TCMSP database and the ingredients were further screened based on their topological characteristics. The active ingredients with nodal degree of freedom≥9 were selected as the main active ingredients. Targets related to aspirin resistance were collected from Genecards database. Drug-active ingredient-target-disease network was constructed by using Cytoscape3. 7. 0,and Funrich 3. 1. 3 software was used for gene enrichment analysis. Sixty main active ingredients were screened out from 110 active ingredients of Danhong Injection,including 51 ingredients in Salviae Miltiorrhizae Radix et Rhizoma and 11 ingredients in Carthami Flos,2 of which were both in Salviae Miltiorrhizae Radix et Rhizoma and Carthami Flos. In addition,159 potential targets were collected. The results of gene enrichment analysis showed that Danhong Injection could improve aspirin resistance mainly through21 pathways involving coagulation process,inflammatory response and metabolism. This study revealed the effects of Danhong Injection for improving aspirin resistance in multi-component,multi-target and multi-pathway means mainly through regulation in coagulation process,inflammatory response and metabolism,providing more abundant information and basis for subsequent research and experimental work.

Impact of aspirin resistance on recurrence of artery atherosclerotic cerebral infarction and risk factors of aspirin resistance / 实用医学杂志

Objective To study the impact of aspirin resistance(AR)on the recurrence of artery athero-sclerotic cerebral infarction,and analyze the risk factors of AR. Methods According to TOSAT classification, newly diagnosed cerebral infarction patients with artery atherosclerotic cerebral infarction were selected into groups,and aspirin enteric-coated tables(ASP)was used to prevent platelet aggregation.One week later,the inhi-bition rate of platelet was detected by thrombelastogram(TEG),and the patients were divided into aspirin sensi-tive(AS)group and AR group,and were followed-up for at least 6 months.According to whether they were recur-rent cerebral infarction,the patients were divided into recurrent group and non-recurrent group. Then,statistical analysis was conducted.Results The incidence rate of AR in recurrent group was significantly higher than that in non-recurrence group(P < 0.05);the recurrence rate of cerebral infarction in AR group was significantly higher than that in AS group(P<0.05).When compare the clinical indexes between the recurrence group and non-recur-rence group,age,diabetes,TC,Hcy,Apo-a in the two groups were different(P<0.05).In recurrent group,the distribution of diabetes,LDL-C and Hs-CRP were different between AR and AS group(P<0.05).Age,gender, hypertension,diabetes,Hs-CRP and TC were risk factors for AR.Conclusions AR plays an important role in the relapse of artery atherosclerotic cerebral infarction and it is more likely to occur especially accompanied by adverse factors such as underlying diseases. TEG can be used to detect AR rapidly and conveniently,which has practical significance in preventing recurrent cerebral infarction.

Effects of breviscapine combined with aspirin on aspirin resistance in elderly patients with coronary heart disease / 中国生化药物杂志

Objective To investigate the effect of breviscapine combined with aspirin on aspirin resistance and clinical effect in elderly patients with coronary heart disease.Methods A total of 178 patients with angina pectoris treated in our hospital from January 2014 to December 2015 were randomly divided into two groups,with 89 cases in each group.The control group received 100 mg oral administration of aspirin.The study group was given breviscapine tablets oral on the basis of the control group.After six months of treatment, aspirin resistance, hemorheology, serum lipid peroxides(LPO), superoxide dismutase(SOD), homocysteine(Hcy), hypersensitivity C-reactive protein(hs-CRP) and interleukin-6(IL-6) were measured.The incidence of clinical efficacy and end points was statistically analyzed.Results The rates of aspirin resistance, whole blood high shear viscosity, whole blood low shear viscosity, plasma viscosity, erythrocyte aggregation index, fibrinogen, LPO, Hcy, hs-CRP, IL-6 levels and end point events in the study group were lower than the control group(P<0.05).The level of SOD and the clinical efficiency were higher than those of the control group(P<0.05).Conclusion Breviscapine combined with aspirin in the treatment of senile coronary heart disease can reduce aspirin resistance, improve clinical effect, reduce the incidence of end points, with clinical value.

Brief Analysis of Aspirin Resistance and Its Implications / 中国药学杂志

OBJECTIVE: Individuals taking aspirin but who fail to appropriately respond to the medication may remain at higher risk of thrombotic events. To provide reference for rational use of aspirin and reduce the risk of adverse reactions, clinical pharmacists need to comprehend the status of aspirin resistance. METHODS: We have reviewed, analyzed, and summarized domestic and foreign literatures published in the last five years that are related to aspirin resistance. RESULTS: The term "aspirin resistance" still has no standard accepted definition in the literature. Researchers focus on molecular insights into the mechanisms of aspirin resistance. The absolute as well as relative contributions of various factors to the phenomenon of aspirin resistance are the subject of current research. There are diverse platelet function testing methods and each has its strengths and weaknesses, which will greatly increase the difficulty of selection. CONCLUSION: In order to have a comprehensive assessment and interpretation of laboratory data, clinical pharmacists need to understand the research progress of aspirin resistance, which will promote personalized medication of aspirin.

Analysis on Drug Therapy in a Patient with In-stent Restenosis / 中国药学杂志

OBJECTIVE: To discuss the drug therapy in a patient with in-stent restenosis, and explore the work forms of pharmacists in the department of cardiology. METHODS: Two causes for in-stent restenosis were summarized by pharmacists, which the patient was noncompliance or poor quality of drugs. Then pharmacists gave feasible suggestions to improve drug therapy by searching literatures and consulting patients. RESULTS: After regular administration of aspirin in our hospital, the symptoms improved and laboratory test showed poor. The outcome of follow-up in 5th month is normal. CONCLUSION: Pharmacists identify adverse events and help physicians to make individual drug therapy to ensure patient safety, effectiveness and economy.

Variabilidad de la respuesta plaquetaria a la aspirina / Assessing platelet response to aspirin

Introducción y objetivos: A pesar de que el estudio Antiplatelet Trialists' Collaboration demostró una reducción del 25% de los eventos mayores con el uso de aspirina en enfermos de alto riesgo, un porcentaje de pacientes presentan eventos isquémicos recurrentes. Esto ha llevado a la descripción de la "resistencia a la aspirina" con una tasa muy variable, de 0.4% a 83%. Este estudio evaluó la variabiliad en la función plaquetaria basal, la prevalencia de la resistencia a la aspirina, y la efectividad y reproducibilidad de los estudios de función plaquetaria. Materiales y métodos: Se llevó a cabo un estudio aleatorizado y cruzado de mediciones repetidas, con sujetos saludables de entre 18 y 60 años. Luego de firmar el consentimiento informado, los pacientes fueron distribuidos en forma aleatorizada a recibir aspirina en dosis de 75 mg o 300 mg; fueron evaluados al inicio y luego de cuatro períodos de tres semanas mediante diferentes técnicas: Optical Platelet Aggregation (OPA), PFA-100™, VerifyNow™, y los niveles séricos y urinarios de tromboxano B2 (TXB2). Se obtuvo la aprobación del comité de ética local. El análisis estadístico fue realizado con el programa SPSS17. Resultados: El índice global de resistencia a la aspirina fue variable, entre 2.4% y 63.5% en función de la técnica utilizada. Se demostró una variabilidad interindividual e intraindividual significativa al inicio y con la administración de placebo en las diferentes técnicas. La sensibilidad de los ensayos varió entre 24% (OPA ADP10) y 87.8% (tromboxano sérico), y la especificidad varió entre 81% (PFA-100™) y 97.4% (tromboxano). La selección de "valores de corte" alternativos provocó tasas de prevalencia diferentes de resistencia bioquímica a la aspirina, con un mecanismo de compensación entre la sensibilidad y la especificidad. Conclusiones: La respuesta a la aspirina mostró una marcada variabilidad interensayo, interindividual y temporal. Se requieren varias evaluaciones con diferentes técnicas para diagnosticar en forma confiable la resistencia a la aspirina. La selección de valores discriminativos alternativos debería considerarse al evaluar formalmente esta entidad

Introduction: Despite the 25% reduction in major events with aspirin in high-risk patients reported by the Antiplatelet Trialists' Collaboration, a proportion of patients develop recurrent ischaemic events. This has led to the emergence of 'aspirin resistance' with rates between 0.4% and 83% reported. This study assessed variability in baseline platelet function, prevalence of aspirin resistance, and the performance and reproducibility of platelet function testing methods. Materials and Methods: A repeated-measures randomised crossover study was performed in healthy individuals aged 18-60 years. After informed consent, patients were randomised to aspirin dose (75 mg or 300 mg) and treatment sequence with testing at baseline and after each four 3-week treatment period via Optical Platelet Aggregation (OPA), PFA-100™, VerifyNow™, and serum and urinary thromboxane (TXB2) levels. Local ethical approval was granted. Statistical analysis was performed using SPSS17. Results: The overall rate of aspirin resistance varied from 2.4% to 63.5% depending on the assay used. Significant inter- and intra-individual variability existed at baseline and on placebo testing between assays. Assay sensitivities ranged from 24.0% (OPA ADP10) to 87.8% (serum TXB2), and specificities from 81.0% (PFA-100™) to 97.4% (serum TXB2). Selection of alternative "cut-off" values resulted in differing prevalence rates of biochemical aspirin resistance with a trade-off between sensitivity and specificity. Conclusions: Response to aspirin shows marked inter-assay, inter-individual and temporal variability. Testing on multiple occasions using several assays is necessary to reliably diagnose aspirin resistance. Selection of alternative assay "cut-off" values should be considered when formally assessing aspirin response

Gene Polymorphism of Aspirin Resistance and Individualized Treatment / 中国药房

OBJECTIVE:To provide theoretical foundation for individualized treatment of aspirin in patients with cardiovascu-lar disease. METHODS:Domestic and foreign literatures in recent years were collected and summarized. RESULTS & CONCLU-SIONS:The gene polymorphism can significantly affect the platelet activity. GPIII a PLA2,PEAR1 and PTGS1 alleles are associat-ed with aspirin resistance,and cardiovascular events have significant difference in different genotype patients. Adjusting reasonably dosage regimen and conducting individualized treatment according to the genetic testing result and other factors can reduce aspirin resistance and the incidence of cardiovascular adverse events in the patients.

Correlation Study Between Aspirin Resistance and COX1, COX2, TBXA2R Gene Polymorphisms in Patients With Coronary Artery Disease / 中国循环杂志

Objective: To explore aspirin resistance (AR) phenomenon in patients with coronary artery disease (CAD) for secondary prevention and to study the relationships between AR and COX1, COX2, TBXA2R gene polymorphisms. Methods: A total of 2881 CAD patients taken aspirin (100 mg/day) in 7 consecutive days were enrolled. Among them, 2 groups were established as AR group, n=166 and Control group, n=200 aspirin sensitive patients. Platelet aggregation function was induced by arachidonic acid (AA), COX1, COX2 and TBXA2R gene polymorphisms were examined by polymerase chain reaction-restricted fragment length polymorphisms (PCR-RFLP) method. Results: The occurrence rate of AR was 5.76% (166/2881). There were 8 tagSNPs locus in 3 genes as in COX1:(rs3842788), (rs4273915), (rs7866582); in: COX2 (rs3218625); in TBXA2R: (rs2238630), (rs2238631), (rs2238633), (rs3786989). The frequencies of wild type, heterozygous genotype and homozygous genotype were similar between 2 groups. Conclusion: The incidence rate of AR is not high in CHD patients with regular aspirin medication; single nucleotide gene polymorphisms of COX1, COX2 and TBXA2R have no obvious correlation to AR.

Association between rs689466 in COX-2 gene and aspirin resistance in cerebral infarction patients / 实用医学杂志

Objective To investigate the association of single nucleotide polymorphisms (SNPs) in COX-2 with aspirin resistance in Chinese cerebral infarction patients. Methods A total of 150 Chinese cerebral infarction patients were recruited. Platelet aggregation response was measured by light transmission aggregometry method and four SNPs located in COX2 gene were genotyped by sequencing method. Results Sixty patients of the total were classified as aspirin non-responders. For clinical variables , concentrations of high homocysteine and the frequency of recurrence cerebral infarction were significantly higher in aspirin non-responders when compared with aspirin responders. Univariate analysis of SNPs showed that rs20417 , rs689465 and rs689466 were significantly associated with aspirin resistance. Multivariate analysis indicated that after adjusting other SNPs and clinical risk factors, rs20417 and rs689466 were still significantly associated with aspirin resistance. Conclusions Rs689466 is significantly associated with aspirin resistance in Chinese cerebral infarction patients even after the adjustment of rs20417. By combining rs689466 , rs20417 and other clinical risk factors , we may better classify the aspirin non-responders from aspirin responders.

Resistencia a la aspirina / Aspirin resistance

Los antiinflamatorios no esteroideos comprenden un grupo heterogéneo químicamente de sustancias que comparten acciones terapéuticas. Entre ellos la aspirina o ácido acetil salicílico. Este es el agente analgésico antiplaquetario y antipirético de mayor consumo y el patrón de referencia para valorar los demás fármacos. A su vez, es el antiagregante plaquetario más utilizado en el mundo. Sin embargo se habla hoy en día sobre el término de resistencia a la aspirina, su diagnóstico y su relevancia clínica como un factor importante de la eventual falla terapéutica de este medicamento.

Non steroideal anti-inflammatory drugs consist of a chemically heterogeneous group of substances that share the same therapeutic actions. Including aspirin or acetylsalicylic acid. This is the antiplatelet agent analgesic and antipyretic of higher consumption and represents the refference pattern for testing other drugs. In addition , it is the most widely used antiplatelet agent in the world . The term aspirin resistance is frequently used, it entails a diagnosis and has a clinical relevance being an important issue for the eventual therapeutic failure of this drug.

Prevalence of Aspirin Resistance in Diabetic Patients and its Associated Factors

Background: Aspirin resistance has posed a major dilemma in the prevention of cardiovascular disease and stroke. There have been many factors that have been associated with aspirin resistance. Among these factors, the inflammatory processes of diabetes and glycaemic control have been significantly associated with aspirin resistance. Our study evaluated the prevalence of aspirin resistance and its associated factors. Methods: This was a cross-sectional, interventional study, which was implemented from October to November 2012 at the Hospital Universiti Sains Malaysia (HUSM). Sixty-nine patients with diabetes who were taking aspirin were enrolled. The glycosylated haemoglobin (HbA1c) and C-reactive protein (CRP) levels were measured in these patients. The thromboelastography (TEG) level was measured using a TEG machine by a trained technician employing standard methods. The variables obtained were analysed for prevalence of aspirin resistance, HbA1c, CRP, and TEG level. The Chi-square test (and Fisher exact test where applicable) were used to evaluate the associations between aspirin resistance with glycaemic control (HbA1c) and inflammatory markers (CRP). Results: The prevalence of aspirin resistance was 17.4% (95%; CI 9.3, 28.4). Glycaemic control (HbA1c) and inflammatory markers (CRP) were not associated with aspirin resistance. Aspirin resistance was prevalent in our study population and was comparable to other studies. The mean HbA1c in the aspirin-resistant group was 8.9%, whereas the mean HbA1c in the aspirin-sensitive group was 8.6%. Conclusion: There was no significant difference in HbA1c between the two groups. There was no significant association between CRP levels and aspirin resistance.

Study on gene polymorphism in patients with aspirin resistance / 中国生化药物杂志

Objective To explore the correlation between aspirin resistance and COX-1, P2Y1, GPIa and GPIIIa gene polymorphism. Methods 35 case with aspirin resistant were selected and were given aspirin enteric coated tablets for oral treatment, 14 days.After the determination COX-1, P2Y1 and GPIa and GpIIIa gene polymorphism of each patient were analysis.Results The genotype AA of COX1 (A-842G) locus and CC of COX1 (C50T) locus was higher than other genotype (P<0.05);AG of P2Y1 (A1622G) locus genotype and CC of P2Y1 (C893T) locus genotype was higher than other genotype (P<0.05);CT of GPIa (C807T) locus genotype and GA of GPIa (G873A) locus genotype was higher than other genotype (P<0.05);PLA1/A1 of GPⅢa(T1565C)locus genotype was higher than other genotype (P<0.05).Conclusion P2Y1 (C893T), GPIa (C807T) allele is associated with aspirin resistance,With COX-1 (A-842G, C50T), GPIa (G873A), GP III A (T1565C), P2Y1 (A1622G) allele is more likely to induce the occurrence of aspirin resistance.

Aspirin, Cardiovascular and Cerebrovascular Diseases / 中国生化药物杂志

Cardiovascular and cerebrovascular diseases is the most fatal diseases in the world.The prevention and treatment of cardiovascular and cerebrovascular diseases are both basic and clinical focus.Aspirin has been used as a prevention medicine in cardiovascular and cerebrovascular diseases for over a century, which is the longest one in history.Aspirin use is estimated at 100 billion tablets annually as an analgesic, antipyretic and antiplatelet drugs.However, there are still many new findings about aspirin, such as aspirin resistance and aspirin hydrolase.This paper reviews the current research advances and future directions of aspirin in cardiovascular and cerebravascwlar diseases, mainly focuses on aspirin resistance and personalized medication.