Fatih AKSOY, Hasan Aydın BAŞ, Ali BAĞCI, Ercan VAROL, Ahmet ALTINBAŞ

Akut Koroner Sendrom ile Başvuran Hastalarda Asetil Salisilik Asit Direncinin Araştırılması

Giriş ve amaç: Akut koroner sendrom (AKS) ile başvuran ve/veya stent uygulanan hastalarda klopidogrel ve aspirin tedavisi günümüzde standart tedavidir. Bununla beraber klopidogrel tedavisine yanıtsızlık olumsuz sonuçlarla ilişkili olması nedeni ile günümüzde önemli bir sorundur. Antitrombositer ilaçların etkinliğini ölçmek için kullanılan trombosit fonksiyon testleri çoğu kez pahalı, zaman alıcı ve ulaşılması zor testlerdir. Aspirin ve klopidogrel direncini saptamak için pratik, kolay uygulanabilinir, ucuz ve güvenilir parametrelere ihtiyaç vardır. Metot: Akut Koroner Sendrom tanısı ile klopidogrel ve aspirin kullanan 531 hasta çalışmaya alındı. Alınan kan örneklerinde MEA (multiple electrod aggregometry) ile çalışıldı. Sonuçlar eğri altında kalan alan (AUC) cinsiden verildi. AUC>500 olması aspirin direnci olarak yorumlandı. Bulgular: Toplamda 45 (%8,5) hastada ise aspirin direnci saptandı. Aspirin direnci için ise diyabet, hiperlipidemi, ürik asit düzeyi, LDL kolesterol düzeyi, non-HDL kolesterol düzeyi, kalsiyum düzeyi, trombosit sayısı, risk faktörü olarak tespit edildi. Sonuç: Bu çalışma; Diyabet, hiperlipidemi, LDL kolesterol düzeyi, non-HDL kolesterol düzeyi, kalsiyum düzeyi, trombosit sayısı, aspirin direncini ön görmede kullanılabilecek bir parametre olduğunu gösterdi.

Anahtar Kelimeler:

Aspirin direnci, akut koroner sendrom, risk faktörleri

Investigation of acetylsalicylic acid resistance in patients with acute coronary syndrome

Background: Aspirin and clopidogrel therapy is the standard of care in patients with acute coronary syndrome (ACS) and stent implantation. However, Clopidogrel and aspirin resistance are arising increasingly. As this nonresponsiveness is associated with increased adverse outcome, detection of these subjects in daily practice is important in order to withhold a more aggressive therapy and closer follow up. The platelet function tests for measurement aspirin and clopidogrel resistance are very expensive and time consuming. We need have practically, easily accessible, cheaper and reliable parameters for detecting aspirin and clopidogrel resistanceMethods: A total of 541 patients who had been on clopidogrel and aspirin therapy for the diagnosis of acute coronary syndrome were enrolled in this study. Aspirin resistance was analyzed by Multiplate MP-0120 device by using the method of whole blood aggregometry. The amount of ADP induced platelet aggregation was assessed as area under curve (AUC), and a cut off value of 500 for aspirin resistance, above which the patient is considered as aspirin resistant, was used. Results: Among the 541 patients analyzed, 45 were found aspirin nonresponder (8.5%). Diabetes Mellitus, Hyperlipidemia, calcium levels, platelet levels, were predictory factor for aspirin resistance. Conclusion: This study showed that diabetes mellitus, hyperlipidemia, calcium levels, platelet levels are associated with aspirin resistance especially in patients with ACS.

Keywords:

aspirin resistance, acute coronary syndrome, risk factors,

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