Lege Artis Medicinae

[Clinical impact of acetylsalicylic acid resistance in patients with cerebrovascular disease]

FEHÉR Andrea, PUSCH Gabriella, HARANG Gábor, GASZTONYI Beáta, PAPP Előd, WERLING Dóra, MENYHÁRT Marianna, KOMÁROMY Hedvig, SZAPÁRY László, FEHÉR Gergely

NOVEMBER 20, 2011

Lege Artis Medicinae - 2011;21(11)

[INTRODUCTION - In the past few years, a number of studies have been published about acetylsalicylic acid resistance and its potential clinical consequences. PATIENTS AND METHODS - 281 patients with chronic cerebrovascular disease have been involved in our study. The patients were divided in two groups on the basis of their optical aggregometer results (acetylsalicylic acid responder vs. resistant). We compared the risk profiles, drug therapies, laboratory parameters and clinical outcomes of the two groups. RESULTS - Acetylsalicylic acid resistant patients were more likely to be women [23 (45.1%) vs. 92 (40%) (p<0.05)], to smoke (38% vs. 25%), have hypertension (92 vs. 78%), hypercholesterolaemia (5.69 vs. 4.85 mmol/l), and elevated LDL-levels (3.71 vs. 2.85 mmol/l), triglyceride levels (2.78 vs. 1.97 mmol/l) and hsCRP levels (17.89 vs. 7.09 mmol/l) (p<0.01). The use of statins was more frequent (56% vs. 36%) in the responder group (p<0.01). Platelet aggregation values (triggered by agonists) were significantly correlated with cholesterol, LDL, triglyceride and hsCRP levels (p<0.05). Adverse outcomes were reached in 13 (25.5%) acetylsalicylic acid nonresponders and 32 (13.9%) acetylsalicylic acid responder patients (p<0.01). In a multivariate analysis, however, only smoking (OR: 2.38, CI: 1.77-5.44) and increased LDL (OR: 3.01, CI: 2.34-5.67) and hsCRP levels (OR: 2.44, CI: 1.55-7.02) (p<0.05) were independent risk factors of adverse vascular outcomes. CONCLUSION - On the basis of our results, acetylsalicylic acid resistance was associated with a worse clinical outcome, but it was not an independent risk factor of future ischaemic events. Our results implicate that inappropriate prevention therapy might have a role in this phenomenon.]

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