Resistencia al ácido acetil salicílico en pacientes con enfermedad coronaria / Acetylsalicylic acid resistance in patients with chronic ischemic heart disease

RESUMEN

Introducción: la anti-agregación plaquetaria es piedra angular en el tratamiento de la enfermedad cardiovascular. El ácido acetil salicílico es la terapia de elección en dosis entre 81-325 mg para la prevención y tratamiento de la enfermedad coronaria.Objetivo: caracterizar la agregación plaquetaria en sujetos con enfermedad coronaria estable, consumidores de ácido acetil salicílico, para determinar la prevalencia de resistencia.Metodología: previa aprobación por los Comités de Ética y de Investigaciones de la Institución, se efectuó un estudio descriptivo transversal en sujetos de 40 años y mayores, con diagnóstico de angina estable que ingresaron para realización de angiografía coronaria. Se obtuvo una muestra de sangre venosa periférica para determinar la agregación plaquetaria mediante ácido araquidónico, epinefrina, colágeno y ADP en un agregómetro HELENA PACKS-4. La resistencia al ácido acetil salicílico se definió al tener agregaciones con ácido araquidónico mayores al 20 porciento. El análisis estadístico se desarrolló con la prueba exacta de Fisher, prueba t de Student y Mann-Whitney de acuerdo con la distribución de las variables...

ABSTRACT

Introduction: platelet anti-aggregation is the «corner stone¼ in the treatment of cardiovascular disease. Acetylsalicylic acid is the therapy of choice in the prevention and treatment of coronary disease, in doses of 81 – 325 mg. Objective: to assess platelet aggregation in subjects with stable coronary disease receiving acetylsalicylic acid, in order to determine its prevalence resistance. Methods: cross-sectional descriptive study in 71 subjects of 40 or more years of age with diagnosis of stable angina, who were admitted for coronary angiography performance. A peripheral venous blood sample was obtained in order to determine the platelet aggregation through arachidonic acid, epinephrine, collagen and ADP in a HELENA PACKS-4 aggregometer. Resistance to the acetylsalicylic acid was defined when having aggregations greater than 20% with arachidonic acid. The statistical analysis was developed with the exact Fisher t test of Student and Mann-Whitney according to variable distribution. Results: 71 subjects were included; 51 were male (71.8%); mean age 63.5 ± 9.4 years. Risk factors 52 (73.2%) had dyslipidemia, 48 (67.6%) arterial hypertension, 15 (21.1%) diabetes mellitus and 9 (12.7%) were cigarette smokers; in 31 (15.9%) arteriography showed one-vessel coronary disease, and multi-vessel disease in 58 (81.7%). The platelet aggregometric values obtained were ADP 64 ± 19.1%, collagen 72 ± 18.9%, epinephrine 43.8± 23.9% and arachidonic acid 26.1 ± 33.7%, being this one the best marker in the acetylsalicylic acid's effect. The prevalence of aspirin resistance was 28.2% (IC 95% 18.1 -40.1). Conclusion: in our population, acetylsalicylic acid resistance is highly prevalent; for this reason, routine measurement of platelet aggregation in high risk patients must be considered, as well as the addition of another anti-aggregation drug (dual therapy) that may guarantee a better anti-thrombotic protection in patients with coronary disease.