The Risk Factors And Clinical Intervention Of Aspirin Resistance

Objective:Aspirin resistance is common in patients with cerebral infarction.It has been reported that aspirin resistance is closely related to the recurrence of cerebral infarction,and increased the infarct volume and other vascular events.The paper investigated the risk factors of aspirin resistance in cerebral infarction,and to study the incidence and prognosis of aspirin resistance after adjustment of antiplatelet drugs.Methods:A total of 269 cases of new onset cerebral infarction patients are recruited from the Department of Obstetrics of the Affiliated Hospital Of Qingdao University Medical College during the period from January 2015 to February 2016.The diagnosis of cerebral infarction is consistent with the guideline of diagnosis and treatment of ischemic stroke in China 2014.Each patient oral aspirin 100mg/d.Of the 269 patients,a subgroup of subjects with aspirin resistance were selected on the basis of the results of thrombelastogram.Analysis of the risk factors,and aspirin resistance were randomized equally in three groups: Group A oral aspirin 200mg/d,Group B oral aspirin 100mg/d+ clopidogrel 75mg/d,Group C oral aspirin 100mg/d,platelet aggregation tests were repeated after at least one month,then compare the rate of platelet inhibition.Followed up for 12 months to observe the occurrence of vascular events and death.Result:The occurrence rate of AR was 33.5%.Univariate analysis showed that the age between aspirin resistance group(AR)and aspirin sensitive group(AS)was statistically significant(P=0.029);logistic regression analysis showed that age is the risk factor of aspirin resistance in patients with cerebral infarction(OR=1.026,95%CI:1.002 ~ 1.049,P=0.030).Platelet inhibition rate was compared between the three groups before and after treatment with antiplatelet drugs: platelet inhibition rate of group A(aspirin 200mg)and group B(aspirin 100mg+clopidogrel 75mg)increased significantly(P(27)0.01,P(27)0.01),while there was no significant difference in platelet inhibition rate before and after treatment in group C(aspirin=100mg)(P=0.303).There was a significant difference between the three groups after treatment(p=0.000),platelet inhibition rate of group A(aspirin=200mg)and group B(aspirin 100mg+clopidogrel 75mg)increased significantly than group C(aspirin=100mg)(P=0.000,P=0.000),and platelet inhibition rate of group B(aspirin 100mg+clopidogrel 75mg)increased more significantly(P=0.004).After aspirin dosage and combined with clopidogrel treatment,38 cases changed to aspirin sensitive(63.33%),22 cases still remaind aspirin resistance(36.67%),the single factor analysis showed that the difference was not statistically significant between age,gender,hypertension,diabetes,coronary heart disease,smoking,drinking,drug combination,blood lipid level and blood sugar level in two groups(P>0.05).After 12 months of follow-up,the difference of the overall ischemic events in three groups was statistically significant(P=0.002),there was no significant difference of the rate of ischemic events between group A(aspirin=200mg)and group B(aspirin 100mg+clopidogrel 75mg)(P(29)0.05),and the overall rate of ischemic events in group C was significantly higher than the other two groups;there was no significant difference in the incidence of hemorrhagic events between the three groups(P > 0.05).Conclusion:Age is a risk factor for aspirin resistance;increased aspirin dose or aspirin plus clopidogrel can effectively improve aspirin resistance,and can reduce or avoid the occurrence of ischemic events.