Clinical Features And The Analysis Of Related Factors Of Aspirin Resistance In Senile Cerebral Infarction Patients

BACKGROUNDAspirin is widely used in one or two grade prevention of cardiovascular and cerebrovascular diseases because of its powerful activity of antiplatelet aggregation. But aspirin on platelet aggregation is not valid for all patients, for although some patients have had antiplatele regularly and adequately, they still have cardiovascular and cerebrovascular events. Therefore some people put forward the concept of aspirin resistance (AR). Aspirin resistance (AR) means that aspirin treatment fails to achieve the expected biological effects (such as inhibition of platelet aggregation, inhibit the biosynthesis of thromboxane or prolonged bleeding etc.) or failed to prevent arteriosclerosis thrombosis events. Aspirin resistance increases the risk of thrombotic events and cardiovascular related deaths. Therefore if we can find the related risk factors of aspirin resistance, we will help clinicians to use reasonable treatment to avoid the recurrence of cardiovascular and cerebrovascular events. For now, there are less reports about detection of platelet inhibition rate and its related influencing factors using thromboelastogram(TEG) among senile cerebral infarction patients. In this paper, we devided senile cerebral infarction patients into aspirin resistance group, aspirin semi-resistance group and aspirin sensitive group by the rate of aspirin inhibition from thromboelastography, and explore the possible risk factors of aspirin resistance so that we can provide basis for clinical prevention and treatment of senile cardiovascular and cerebrovascular diseases and provide important guidance for individualized treatment for patients with aspirin resistance.OBJECTIVEExplore the phenomenon of aspirin resistance and its related factors in patients taking100mg aspirin each day with cerebral infarction.METHODSSelect86patients (age82.39+3.17years) with cerebral infarction who took100mg of aspirin daily for at least seven days of continuous use, then detect platelet inhibition rate after taking aspirin through thrombelastography of our hospital. The inhibition rate of less than20%is aspirin resistance (AR), more than50%is aspirin sensitive(AS) and between20%and50%is aspirin semi-resistance (ASR).We recorded weather those patients had hypertension, diabetes, coronary heart disease, smoking and drinking history and so on. Collect fasting blood and detect blood glucose (FBG), triglyceride (TG), total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL), lipoprotein a, age, uric acid, blood platelet count (PLT), mean platelet volume (MPV), platelet volume distribution width (PDW), platelet hematocrit (PCT), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), homocysteine, maximum blood flow velocity (Vmax) and resistance index (RI) of the bilateral carotid artery, vertebral artery using vascular color Doppler ultrasound in our hospital, then analyse the difference of all the clinical characteristics and risk factors between the groups with statistical method.RESULTS1. The incidence of AR and ASR in senile cerebral infarction patients with aspirin daily was45.35%.2.Patients in AR and ASR group had higher blood glucose, TCH, LDL, uric acid, smoking than those in AS group, but the difference was not statistically significant (P>0.05).3. There was statistical significance difference (P<0.05) in TG, left carotid artery resistance index, APTT, which have some relationship with aspirin resistance, while they are all not the independent risk factors of aspirin resistance through the Logistic regression analysis (P>0.05). 4. In the patients from75to84years old, fasting blood glucose, triglyceride, total cholesterol, low density lipoprotein and other biochemical indexes in AR and ASR group were higher than those in AS group, but there was no significant difference (P>0.05), and APTT showed a sastatistically significant difference of APTT between the two groups (P<0.05), while it is still not the independent risk factor of aspirin resistance through the Logistic regression analysis (P>0.05)5. In the patients of older than85years old, fasting blood glucose, triglyceride, low density lipoprotein, platelet count, uric acid, lipoprotein a, homocysteine, total cholesterol in AR and ASR group were higher than those in AS group, but the difference was not statistically significant (P>0.05). Although the average age, high density lipoprotein, APTT, left common carotid artery blood flow velocity and the left common carotid artery resistance index of AR and ASR group were lower than those of AS group, there was still no significant difference (P>0.05).6. There was a significant difference between the patients with aspirin resistance among different age range(P<0.05). Patients of older than85years old are less likely to get aspirin resistance.CONCLUSION1. There is aspirin resistance among senile cerebral infarction patients. There is a significant difference between the patients with aspirin resistance among different age range, and patients of older than85years old are less likely to get aspirin resistance.2. TQ left carotid artery resistance index and APTT are associated with aspirin resistance in those senile cerebral infarction patients. But they are not independent risk factors.3. Blood glucose, TCH, LDL, PLT, PDW, HDL, uric acid, homocysteine, smoking and hypertension are not associated with aspirin resistance.