Aspirin resistance status as determined by urinary thromboxane B2 (TXB2) level in patients with ischemic heart disease and its relationship with Severity of coronary artery disease

Document Type : Original Article(s)

Authors

1 Resident, Department of Cardiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

2 Associate Professor of Cardiology, Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

3 Fellowship of Cardiology, Isfahan University of Medical Sciences, Isfahan, Iran.

4 Medical Student, Isfahan University of Medical Sciences, Isfahan, Iran.

5 PhD, Isfahan University of Medical Sciences, Isfahan, Iran.

6 Professor of Cardiology, Isfahan University of Medical Sciences, Isfahan, Iran.

Abstract

Background: Coronary artery disease (CAD) and myocardial infarction are the most common cause of mortality and morbidity all over the world.. Aspirin resistance is an important part of therapeutic failure in patients who experience several atherosclerotic events despite aspirin therapy.Different stud-ies have reported aspirin resistance between 5-45% all over the world. According to different re-sponses to aspirin therapy in different countries and lack of adequate studies on aspirin resistance in Iran, this study was designed for invitro evaluation of aspirin resistance in Iranian patients .
Methods: 170 patients with documented coronary artery stenosis were enrolled in this cross-sectional prospective study. 2 cc urine samples were obtained from all the subjects.Then a questionnaire includ-ing questions about ischemic heart disease risk factors (hypertension, diabetes, hyperlipidemia, obesity and smoking) was completed for each patient. Thromboxane B2 level in urine was measured two times for each patient via ELISA method. Data were analyzed via SPSS 16. with General Linear Model (Univariate).Gensini modified was used for assessment of severity of coronary arteries in-volvement (Coronary angiography score).
Finding: 75.3% of studied patients were aspirin resistant. There was significant relationship between angiography score and aspirin resistance (Pvalue

Keywords


  1. Collaborative overview of randomised trials of antiplatelet therapy--I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Antiplatelet Trialists' Collaboration. BMJ 1994; 308(6921): 81-106.
  2. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002; 324(7329): 71-86.
  3. Vane JR, Bakhlle YS, Botting RM. Cyclooxy-genaz 1 and 2. Annual Review 1998; 38(1): 97-120.
  4. Catella-Lawson F, Reilly MP, Kapoor SC, Cucchiara AJ, DeMarco S, Tournier B, et al. Cyclooxygenase inhibitors and the antiplatelet effects of aspirin. N Engl J Med 2001; 345(25): 1809-17.
  5. Hankey GJ, Eikelboom JW. Aspirin resistance. BMJ 2004; 328(7438): 477-9.
  6. Weber AA, Przytulski B, Schanz A, Hohlfeld T, Schror K. Towards a definition of aspirin resistance: a typological approach. Platelets 2002; 13(1): 37-40.
  7. Smout J, Stansby G. Aspirin resistance. Br J Surg 2002; 89(1): 4-5.
  8. Tarjan J, Salamon A, Jager R, Poor F, Barczi V, Dinnyes J, et al. The rate of acetylsalicylic acid non-respondents among patients hospitalized for acute coronary disease, previously undergoing secondary salicylic acid prophylaxis. Orv Hetil 1999; 140(42): 2339-43.
  9. Patrono C, Coller B, Dalen JE, FitzGerald GA, Fuster V, Gent M, et al. Platelet-active drugs : the relationships among dose, effectiveness, and side effects. Chest 2001; 119(1 Suppl): 39S-63S.
  10. Halushka MK, Walker LP, Halushka PV. Genetic variation in cyclooxygenase 1: effects on response to aspirin. Clin Pharmacol Ther 2003; 73(1): 122-130.
  11. Kasotakis G, Pipinos II, Lynch TG. Current evidence and clinical implications of aspirin resistance. J Vasc Surg 2009; 50(6): 1500-10.
  12. Kim H, Lee HK, Han K, Jeon HK. Prevalence and risk factors for aspirin and clopidogrel re-sistance in patients with coronary artery disease or ischemic cerebrovascular disease. Ann Clin Lab Sci 2009; 39(3): 289-94.
  13. Shen H, Herzog W, Drolet M, Pakyz R, New-comer S, Sack P, et al. Aspirin Resistance in healthy drug-naive men versus women (from the Heredity and Phenotype Intervention Heart Study). Am J Cardiol 2009; 104(4): 606-612.
  14. Pinto Slottow TL, Bonello L, Gavini R, Beauzile P, Sushinsky SJ, Scheinowitz M, et al. Prevalence of aspirin and clopidogrel resistance among patients with and without drug-eluting stent thrombosis. Am J Cardiol 2009; 104(4): 525-30.
  15. Sanioglu S, Tetik S, Sokullu O, Deniz H, Ayde-mir N, Yilmaz M, et al. Aspirin resistance after CABG. Thorac Cardiovasc Surg 2009; 57(5): 281-5.
  16. Acikel S, Yildirir A, Aydinalp A, Bal U, Kaynar G, Ozin B, et al. The clinical importance of laboratory-defined aspirin resistance in patients presenting with non-ST elevation acute coronary syndromes. Blood Coagul Fibrinolysis 2009; 20(6): 427-32.
  17. Akhtar N, Junaid A, Khalid A, Ahmed W, Shah MA, Rahman H. Report: frequency of aspirin resistance in patients with coronory artery disease in Pakistan. Pak J Pharm Sci 2009; 22(2): 230-3.
  18. Bruno A, McConnell JP, Mansbach HH, III, Cohen SN, Tietjen GE, Bang NU. Aspirin and urinary 11-dehydrothromboxane B(2) in African American stroke patients. Stroke 2002; 33(1): 57-60.
  19. Sanderson S, Emery J, Baglin T, Kinmonth AL. Narrative review: aspirin resistance and its clinical implications. Ann Intern Med 2005; 142(5): 370-80.
  20. Sullivan DR, Marwick TH, Freedman SB. A new method of scoring coronary angiograms to reflect extent of coronary atherosclerosis and improve correlation with major risk factors. Am Heart J 1990; 119(6): 1262-7.
  21. 1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension. Guidelines Subcommittee. J Hypertens 1999; 17(2): 151-83.
  22. American Diabetes Association. Clinical practice recommendations. Diabetes Care 1998; 21: S1-S99.
  23. Brewer HB. New features of the National Cho-lesterol Education Program Adult Treatment Panel III lipid-lowering guidelines. Clin Cardiol 2003; 26(4 Suppl 3): III19-III24.
  24. Sarraf-Zadegan N, Baghaii AM, Sadeghi M, Amin Zadeh A. Factor analysis of metabolic syndrome among smokers.. Iran J Med Sci 2005; 30(2): 73-8.
  25. Peterson P. Aspirin resistance: Fact and Fiction. Medscape 2005; 12-20.
  26. Gasparyan AY, Watson T, Lip GY. The role of aspirin in cardiovascular prevention: implications of aspirin resistance. J Am Coll Cardiol 2008; 51(19): 1829-43.
  27. Christiaens L, Ragot S, Mergy J, Allal J, Macchi L. Major clinical vascular events and aspirin-resistance status as determined by the PFA-100 method among patients with stable coronary artery disease: a prospective study. Blood Coagul Fibrinolysis 2008; 19(3): 235-9.
  28. Akay OM, Canturk Z, Akin E, Bal C, Gulbas Z. Aspirin-resistance frequency: a prospective study in 280 healthy Turkish volunteers. Clin Appl Thromb Hemost 2009; 15(1): 98-102.
  29. Singla MK, Lahiri P, Mukhopadhyay P, Pandit K, Chaudhuri U, Chowdhury S. A study of aspirin resistance in type 2 diabetes. J Indian Med Assoc 2008; 106(11):720, 722-3, 740.
  30. Zimmermann N, Hohlfeld T. Clinical implica-tions of aspirin resistance. Thromb Haemost 2008; 100(3): 379-90.
  31. Sanderson S, Emery J, Baglin T, Kinmonth AL. Narrative review: aspirin resistance and its clinical implications. Ann Intern Med 2005; 142(5): 370-80.
  32. Durmaz T, Keles T, Ozdemir O, Bayram NA, Akcay M, Yeter E, et al. Heart rate variability in patients with stable coronary artery disease and aspirin resistance. Int Heart J 2008; 49(4): 413-22.