| Background Ischemic stroke implies brain tissues necrosis or softening due to blood circulation disorders such as ischemia or hypoxia. A large number of medical evidences ascertain that aspirin can significantly reduce the events of embolism and thrombosis from occurring. Consequently, it plays an important role in the prevention of ischemic cerebrovascular diseases mainly through acetylating the active site serine 529 of fatty acid cyclooxygenase-1 (COX-1), preventing the combination between the arachidonic acid (AA) and its acetylated sites, inhibiting the formation of thromboxane A2 (TXA2) and playing an anti-platelet aggregation role. However, in clinical practice, we observed that aspirin is not effective in all cases; there are still events of thrombosis or embolism occurring in patients with cardiovascular diseases during aspirin therapy, this phenomenon is called clinical aspirin resistance. Meanwhile, many laboratory studies have also found that platelet activity in patients during aspirin therapy cannot, in all cases, be sufficiently suppressed, this is called laboratory aspirin resistance. Some studies have shown that laboratory aspirin resistance is closely associated with clinical. Aspirin resistance detection rate not only fluctuates greatly but also depends on specific standard conditions. In Z-H Xu et al.’s research, usage of light transmission aggregometer (LTA), platelet function analyser (PFA), thrombelastograph platelet mapping assay (TEG),11-DH-TXB2 levels and P-selectin were measured to evaluate the effect of aspirin on platelet, although positive P-selectin platelets were established as the standard baseline for platelet activation, the thrombelastograph platelet mapping assay-arachidonic acid (TEG-AA) T platelet mapping experiments, as more simpler, reproducible, was more sensitive, specific, consistent than the P-selectin assay for the detection of aspirin resistance and was more useful in development of individualized antiplatelet therapy. This study utilizes TEG-AA T platelet mapping experiments to determine whether patients are aspirin resistant, through investigating its risk factors in patients with ischemic cerebral stroke, in order to provide basis for clinical prevention and treatment of cerebrovascular disease.Purpose To investigate the risk factors of aspirin resistance in patients with ischemic stroke.Methods 163 patients in the department of neurology of Zhongda Hospital affiliated to Southeast University were enrolled in the study from November 2013 to March 2015, all patients were confirmed having ischemic stroke using brain MRI or CT scan. The enrolled patient’s demographic data, underlying diseases, hematological data, TEG-AA inhibition rates were carefully recorded. Parameters were as follow:TEG-AA inhibition rate<20% defined as aspirin-resistance, 20%<TEG-AA inhibition rate<50% defined as aspirin semi-resistance, TEG-AA inhibition rate>50% defined as aspirin-sensitive, aspirin-resistance and aspirin semi-resistance collectively defined as aspirin non-sensitive. The risk factors of aspirin resistance in patients with ischemic stroke were assessed using correlation analysis.Results A total of 163 cases were included in the study period, among which 132 cases are aspirin sensitive group,31 cases are aspirin non-sensitive group, included 15 cases are aspirin-resistant group,16 cases are aspirin semi-resistant group. Comparison between the aspirin-sensitive group and aspirin non-sensitive group using independent sample t test screening for differences in the distribution of quantitative indicators and chi-square test for differences in the distribution of qualitative indicators, we observed that only the p value of coronary heart disease in both compared groups is<0.05. It means that coronary heart disease is statistically significant between the two groups. The regression analysis showed that the coefficient of coronary heart disease is 0.987, which is positive. Coronary heart disease’s relative risk is 0.373 (0.163,10.852) for aspirin non-sensitive group, indicating that patients with coronary artery disease are more likely to be aspirin non-sensitive. Comparison between aspirin sensitive group and resistant group using independent sample t test screening for differences in the distribution of quantitative indicators and chi-square test for differences in the distribution of qualitative indicators, we observed that the p values of fasting blood glucose and glycosylated hemoglobin (HbAlc) between the two groups are<0.05. It means that fasting blood glucose and glycosylated hemoglobin are statistically significant between the two groups. The regression analysis showed that the P values of fasting blood glucose and glycosylated hemoglobin are>0.05, thus, they can not enter the regression equation. It indicates that glycated hemoglobin and fasting blood glucose are not significant to aspirin resistant group. Comparison between the aspirin sensitive group and semi-resistant group using independent sample t test screening for differences in the distribution of quantitative indicators and chi-square test for differences in the distribution of qualitative indicators, we observed that only the p value of coronary heart disease in both compared groups is<0.05. It means that coronary heart disease is statistically significant between the two groups. The regression analysis showed that the coefficient of coronary heart disease is 1.552, which is positive. Coronary heart disease’s relative risk is 4.720 (1.553,14.352) for aspirin semi-resistant group, indicating that patients with coronary artery disease are more likely to be aspirin semi-resistant. Comparison between aspirin resistant group and semi-resistant group using independent sample t test for differences in the distribution of quantitative indicators and chi-square test for differences in the distribution of qualitative indicators, we observed that the p value of glycosylated hemoglobin in both groups is<0.05. It means that glycosylated hemoglobin is statistically significant between the two groups. The regression analysis showed that the coefficient of coronary heart disease is 0.952, which is positive. Glycosylated hemoglobin’s relative risk is 2.523(1.188,5.357) for aspirin resistant group, indicating that patients with higher glycosylated hemoglobin are more likely to be aspirin resistant.Conclusion The results suggest that a certain number of patients with ischemic stroke in the aspirin treatment are failed to achieve the desired anti-platelet aggregation. This study suggests that people with coronary heart disease and the glycated hemoglobin is a aspirin resistance’ risk factor are aspirin non-sensitive’ risk factors. |
PDF Full Text Request