超過四分之一接受aspirin療法的心臟病患被發現對aspirin有抵抗性


  March 14, 2005(奧蘭多)-中國研究人員發現,心血管疾病患者接受aspirin治療,發生aspirin抵抗性的比例很高;對aspirin的抵抗性已經被認為與心臟病發的風險增加有關。
  
  香港大學瑪麗皇后醫院的Wai-Hong Chen醫師與其同事透過一項研發中的檢驗方法(Ultegra,Accumetrics公司製造,加拿大聖地牙哥),來評估468位冠狀動脈心血管疾病病患的aspirin抵抗性;整體來說,27%的病患對aspirin有抵抗性。
  
  Chen醫師向美國心臟學會2005年會科學座談中的與會人士表示,那些最可能對aspirin有抵抗性的病患,是那些最可能因為心臟疾病而死亡的,包括女性(46.1%)、吸菸者(11.5%)、糖尿病(39.1%)、以及那些有高血壓(72.7%)、高脂血(68.8%)、與腎臟功能不全(18.8%)、以及使用低劑量aspirin(90.6%)的病患。
  
  如同之前所提的,aspirin的劑量會影響發生抵抗性的風險;Aspirin抵抗性發生機率最高的族群是每天服用100毫克以下的病患,而每天服用300毫克以上的病患並沒有發現抵抗性。
  
  Accumetrics的試驗方法評估aspirin誘發的血小板功能不全;透過同樣的方式,德州休士頓Baylor醫學院由Eli Lev醫師領導的團隊表示,aspirin與clopidogrel抵抗性通常會一起發生。
  
  參與試驗的80位病患,15%被發現對aspirin有抵抗性,24%對clopidogrel有抵抗性,而7.5%被發現對這兩種藥物都有抵抗性。
  
  哈佛醫學院及布萊根婦女醫院內科主任Marc Sabatini醫師在一項面談中向Medscpae表示,aspirin與clopidogrel抵抗性的領域正在發展當中,我們必須記住並不是每個人對aspirin都有同樣的血小板抑制程度。
  
  Sabatini醫師指出,對aspirin產生抵抗性的病患發生缺血性事件的風險較高;我們必須要找出那些反應不良的病患。
  
  麻州波士頓布萊根婦女醫院與哈佛醫學院內科副教授Christopher Cannon醫師向Medscape表示,目前為止,aspirin抵抗性的檢驗尚未成熟;這仍然是個熱門的領域,但是我們的方向是對的。

Aspirin Sensitivity Found in M

By Martha Kerr
Medscape Medical News

March 14, 2005 (Orlando) — Chinese investigators report finding a high prevalence of aspirin resistance in patients with cardiovascular disease on aspirin therapy. Aspirin resistance has been linked to an increased risk of adverse cardiac events.

Wai-Hong Chen, MD, from Queen Mary Hospital at The University of Hong Kong, and colleagues measured aspirin resistance in 468 patients with coronary artery disease using an investigational assay (Ultegra, Accumetrics, San Diego, CA). Overall, 27% had aspirin resistance, they found.

Those most likely to have resistance are those most at risk of mortality from their disease. Dr. Chen told attendees of the American College of Cardiology 2005 Annual Scientific Session that the elderly, women (46.1%), smokers (11.5%), diabetics (39.1%), those with hypertension (72.7%), hyperlipidemia (68.8%), renal insufficiency (18.8%), and low-dose aspirin (90.6%) had the highest incidence of resistance.

As noted, aspirin dose affected risk of resistance. The highest incidence of aspirin resistance occurred in those taking 100 mg daily or less, while no resistance was found in those taking more than 300 mg daily.

The Accumetrics assay measures aspirin-induced platelet dysfunction. Using the same test, a team at Baylor College of Medicine in Houston, Texas, led by Eli Lev, MD, showed that aspirin and clopidogrel resistance often occur together.

Of the 80 patients studied, 15% were found to be aspirin resistant, 24% were clopidogrel resistant, and 7.5% were found to be resistant to both.

Marc Sabatini, MD, instructor of medicine at Brigham and Women's Hospital and Harvard Medical School, noted in an interview with Medscape that "the field of aspirin and clopidogrel resistance is still developing.... We have to remember that not everyone will have the same degree of platelet aggregation to aspirin."

"Those with aspirin resistance are at increased risk of ischemic events," Dr. Sabatini continued. "We need to identify hyporesponders."

"The aspirin resistance test is not ready for prime time," Christopher Cannon, MD, associate professor of medicine of Brigham and Women's Hospital and Harvard Medical School in Boston, Massachusetts, told Medscape. "It is still in the field of active research — but we are going in the right direction."

ACC 2005 Annual Scientific Sessions: Abstract 1043-126, presented March 6, 2005; abstract 868.7, presented March 9, 2005.

Reviewed by Gary D. Vogin, MD

    
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