Correlative Factors Analysis Of Aspirin Resistance In Patients With Coronary Heart Disease

Objective:Aspirin as the traditional anti-platelet drug was widely used for the prevention and treatment of cardiovascular diseases. A large number of proofs from the evidence-based medicine supported the important value of aspirin in the secondary prevention of coronary artery disease and the primary prevention of some selected patients. It could reduce the death rate of cardiovascular disease and prevent the occurrence of myocardial infarction. However, not all of the patients can obtain the equal anti-platelet-assemble effect. Despite of the treatment of aspirin with routine dosage, even enlarged dosage, some patients experienced coronary thrombotic events. So the concept of "aspirin resistance"(AR) had been put forward. Aspirin resistance was one of the principal focus for the clinical cardiovascular medicine.The aim of this study was to investigate the prevalence and analyse the correlative factors of aspirin resistance in the patients with the cardiovascular disease who had taken aspirin regularly, which were tested by the platelet aggregation instrument. We expected to find the correlative factors, so that we chould enforce individual treatment and obtain the best effect of anti-platelet in the prevention and treatment of cardiovascular disease.MethodsAll of 264 patients with coronary heart disease aged 42-88 years old (averaged 72±11 years old) were from the Department of Cardiology in Gerontology, Shandong Provincial Hospital during November 2006 and April 2008, which including 189 men and 75 women. All patients had taken aspirin regularly (75-100mg/d) for more than one month, and all patients were diagnosed according to the diagnosis standard for coronary heart disease by WHO in 1979. Additionally, there were 170 patients combined with primary hypertension, 72 patients combined with obsolete cerebral infarction, 76 patients combined with diabetes mellitus and 49 patients combined with hyperlipaemia.1. The fllowing data were collected, as gender,age,plasma glucose(FPG),cholesterol(CH),fibrin(Fib),white blood cell(WBC),red blood cell(RBC),platelet(PLT),hemoglobin(HGB) and other treatments of 264 patients with coronary heart disease.2. Platelet aggregation function induced by adenosine diphosphate (ADP) and collagen (COL) was determined by the whole blood impedance method, According to the result, all patients were divided into three groups: aspirin resistance (AR) group, aspirin semi-resistance (ASR) group and aspirin sensitive(AS) group. AR was defined as a state in which aggregation≥18ohm with COL and that>13ohm with ADP . Aspirin semi-resistance (ASR) was defined as meeting one of the above criteria. If both above criteria were not met, the condition was defined as aspirin sensitive (AS). The difference in clinical characteristics among these groups were analysed to judge the correlative factors of AR.Results1. There were 23 cases's aggregation with COL and ADP were higher than that of normal, the incidence of AR was 8.71%(23 / 264),and 49 cases's aggregation with COL were higher than that of normal, but aggregation with ADP was normal, the incidence of ASR was 18.56%(49 / 264), the whole incidence was 27.27% (72/264) .2. The percentage of female with AR was 47.83% (11/23), the percentage of female with ASR was 32.65% (16/49), and the percentage of female with AS was 25% (48/192), The female in AR were higher than AS. 3. There were 15 patients combined with diabetes mellitus in 23 cases which were AR, occupied 65.22%, 13 patients combined with diabetes mellitus in 49 cases which were ASR, occupied 26.53%,48 patients combined with diabetes mellitus in 192 cases which were AS, occupied 25%, Patients with diabetes mellitus were more likely to occure AR.(P<0.05). The difference was remarkable.4. The concentration of PLT of AR was (245.17±32.97)×10~9/L,ASR was (217.53±52.79)×10~9/L, AS was (191.25±69.27)×10~9/L, The concentration of PLT of AR and ASR groups was higher than AS group. (P<0.05). The difference was remarkable.5. The patients of AR/ASR groups had no relationship with the dosage of aspirin.Conclusion1. Aspirin resistance really existed in the patients with coronary artery disease who had taken aspirin regularily, The prevalences of AR and ASR were 8.71 % (23 / 264) and 18.56% (49 / 264), which made the total prevalence 27.27%2. The event of AR/ASR was likely correlated with gender, the concentration of PLT and diabetes mellitus.