Aspirin resistance detected with aggregometry cannot be explained by cyclooxygenase activity: involvement of other signaling pathway(s) in cardiovascular events of aspirin-treated patients

被引:91
作者
Ohmori, T.
Yatomi, Y.
Nonaka, T.
Kobayashi, Y.
Madoiwa, S.
Mimuro, J.
Ozaki, Y.
Sakata, Y. [1 ]
机构
[1] Jichi Med Sch, Ctr Mol Med, Res Div Cell & Mol Med, Minamimaki, Tochigi 3290498, Japan
[2] Minobusan Hosp, Cent Lab, Yamanashi, Japan
[3] Univ Tokyo, Sch Med, Dept Lab Med, Tokyo 113, Japan
[4] Univ Yamanashi, Fac Med, Dept Lab Med, Yamanashi, Japan
关键词
aspirin; cerebrovascular diseases; coronary heart diseases; cyclooxygenase; platelets;
D O I
10.1111/j.1538-7836.2006.01958.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives: Although the concept of aspirin resistance is extensively reported in medical literature, its precise mechanisms and clinical outcomes are largely unknown. In this study, we examined individual thromboxane biosynthesis and platelet aggregation in aspirin-treated patients, and whether the results of a platelet aggregation test influenced clinical outcomes. Results: Subjects taking 81 mg of aspirin (n = 50) and controls (n = 38) were evaluated for platelet aggregation and platelet cyclooxygenase-1 (COX-1) activity by measuring collagen-induced thromboxane B-2 production. For aggregometry, both light transmission (LT) and laser-light scattering methods were employed to quantitatively evaluate aggregate sizes and numbers. Aspirin treatment resulted in the inhibition of collagen-induced platelet aggregation, particularly the transition from small to large platelet aggregates. Although platelet COX-1 activity seemed to be uniformly inhibited in all patients, platelet aggregation studies showed great inter-individual differences; variation in platelet COX-1 activity only accounted for 6-20% of the individual aggregations. Factor analysis revealed the existence of a common factor (other than platelet COX-1) that explained 48.4% of the variations in platelet aggregation induced by collagen, adenosine diphosphate (ADP), and collagen-related peptide. We then prospectively enrolled 136 aspirin-treated patients in our study, and we found that being in the upper quartile level of LT, or with large aggregate formation induced by collagen, was an independent risk factor for developing cardiovascular events within 12 months [hazard ratio (HR) = 7.98, P = 0.008 for LT; HR = 7.76, P = 0.007 for large aggregates]. On the other hand, the existence of diabetes mellitus was an independent risk factor for overall outcomes (HR 1.30-11.9, P = 0.015-0.033). Conclusions: Aspirin resistance expressed as unsuppressed platelet COX-1 activity is a rare condition in an out-patient population. Other factor(s) affecting collagen-induced platelet aggregation may influence early outcomes in aspirin-treated patients.
引用
收藏
页码:1271 / 1278
页数:8
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