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Incidence of aspirin resistance is higher in patients with acute coronary syndrome and atrial fibrillation than without atrial fibrillation
Bas, Hasan Aydin; Aksoy, Fatih; Bagci, Ali; Varol, Ercan; Altinbas, Ahmet.
  • Bas, Hasan Aydin; Isparta City Hospital. Department of Cardiology. Isparta. TR
  • Aksoy, Fatih; Suleyman Demirel University. Medical School. Department of Cardiology. Isparta. TR
  • Bagci, Ali; Suleyman Demirel University. Medical School. Department of Cardiology. Isparta. TR
  • Varol, Ercan; Suleyman Demirel University. Medical School. Department of Cardiology. Isparta. TR
  • Altinbas, Ahmet; Suleyman Demirel University. Medical School. Department of Cardiology. Isparta. TR
Rev. Assoc. Med. Bras. (1992) ; 66(6): 800-805, June 2020. tab
Article in English | LILACS, SES-SP | ID: biblio-1136291
Responsible library: BR1.1
ABSTRACT
SUMMARY In patients with atrial fibrillation, standard anticoagulation with a vitamin K antagonist plus dual antiplatelet therapy with a P2Y12 inhibitor and aspirin is the standard of care after percutaneous coronary intervention (PCI). While this therapy reduces the risk of thrombosis and stroke, it increases the risk of bleeding. It is unclear whether the antiplatelet effect of aspirin and clopidogrel may worsen atrial fibrillation (AF). OBJECTIVE Thus we aimed to analyze platelet aspirin resistance (AR) and clopidogrel resistance (CR) in acute coronary (ACS) patients based on sinus rhythm (SR) and AF. METHODS In this prospective trial, we included 543 patients (mean age 62± 12 years; range 26 - 89 years) who were on aspirin and clopidogrel therapy after the diagnosis of acute coronary syndrome. AR and CR were analyzed by a Multiplate® MP-0120 device by using the method of whole blood aggregometry. RESULTS AF patients had significantly higher age, mean platelet volume, and High-Sensitivity C-Reactive Protein (p< 0.01 for each parameter). Similarly, Arachidonic-acid induced (ASPI) aggregation was higher in AF patients compared to SR patients (666±218 vs. 187±179, p<0.001). Among the ACS patients, significantly more female patients had AF (p<0.001). The incidence of hypertension in the AF group was higher compared to the SR group (p<0.001). However, adenosine diphosphate levels were not at a significant level in the two groups. CONCLUSION Our findings indicate that the platelet inhibitory effect of Aspirin was worse for patients with AF, suggesting that the effectiveness of aspirin may be less in the prophylaxis of thromboembolism and more a bleeding risk.
RESUMO
RESUMO Em pacientes com fibrilação atrial, a anticoagulação padrão com antagonista da vitamina K mais terapia antiplaquetária dupla (DAPT) com inibidor de P2Y12 e aspirina é o padrão de tratamento após intervenção coronária percutânea (ICP). Enquanto essa terapia reduz o risco de trombose e derrame, aumenta o risco de sangramento. Não está claro se o efeito antiplaquetário da aspirina e do clopidogrel pode piorar a fibrilação atrial (FA). OBJETIVO Analisar a resistência à aspirina plaquetária (AR) e ao clopidogrel (CR) em pacientes coronarianos agudos (SCA) com base no ritmo sinusal (SR) e na FA. MÉTODOS Neste estudo prospectivo, foram incluídos 543 pacientes (idade média 62±12 anos; intervalo 26-89 anos) em uso de aspirina e clopidogrel após o diagnóstico de síndrome coronariana aguda. AR e CR foram analisados por um dispositivo Multiplate® MP-0120, utilizando o método de agregometria de sangue total. RESULTADOS Os pacientes com FA apresentaram valores significativamente maiores para idade, volume médio de plaquetas e proteína C reativa de alta sensibilidade (p<0,01 para cada parâmetro). Da mesma forma, a agregação induzida por ácido araquidônico (Aspi) foi maior nos pacientes com FA em comparação com os pacientes com SR (666±218 vs. 187±179, p<0,001). Entre os pacientes com SCA, significativamente mais pacientes do sexo feminino apresentaram FA (p<0,001). A incidência de hipertensão no grupo FA foi maior em comparação com o grupo SR (p<0,001). No entanto, os níveis de difosfato de adenosina não foram expressivamente significativos nos dois grupos. CONCLUSÃO Nossos achados indicam que o efeito inibitório plaquetário da aspirina foi pior em pacientes com FA, sugerindo que a eficácia da aspirina pode ser menor na profilaxia do tromboembolismo, com maior risco de sangramento.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Atrial Fibrillation / Drug Resistance / Aspirin / Acute Coronary Syndrome Type of study: Incidence study / Risk factors Limits: Adult / Aged / Female / Humans Language: English Journal: Rev. Assoc. Med. Bras. (1992) Year: 2020 Type: Article Institution/Affiliation country: Isparta City Hospital/TR / Suleyman Demirel University/TR

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Full text: Available Index: LILACS (Americas) Main subject: Atrial Fibrillation / Drug Resistance / Aspirin / Acute Coronary Syndrome Type of study: Incidence study / Risk factors Limits: Adult / Aged / Female / Humans Language: English Journal: Rev. Assoc. Med. Bras. (1992) Year: 2020 Type: Article Institution/Affiliation country: Isparta City Hospital/TR / Suleyman Demirel University/TR