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J Postgrad Med. 2009 Oct-Dec;55(4):252-6. doi: 10.4103/0022-3859.58927.

Aspirin resistance in Indian patients with coronary artery disease and cardiovascular events.

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  • 1Department of Cardiology, Christian Medical College and Hospital, Vellore, India.

Abstract

BACKGROUND:

Aspirin resistance is a major problem and its incidence and clinical significance in Indian patients with documented coronary artery disease are not known.

AIM:

We sought to study the incidence of aspirin resistance and its clinical significance in a cohort of Indian patients with coronary heart disease on therapy with aspirin using urinary 11-Dehydrothromboxane B2 levels as a surrogate marker for antiplatelet efficacy.

SETTING AND DESIGN:

Non randomized single center prospective study in cohort of patients with stable cardiovascular disease on chronic aspirin therapy attending the cardiology outpatient clinic of a tertiary care hospital.

MATERIALS AND METHODS:

Urinary dehydrothromboxane levels were analyzed in a cohort of 63 patients with stable documented coronary artery disease and in 21 healthy volunteers. The cases were followed up prospectively for a median period of 36 (1-53) months. The clinical endpoint was a composite of acute coronary syndrome, stroke, revascularization and death.

STATISTICAL ANALYSIS:

Comparison of urinary dehydrothromboxane concentration values between various risk factors was done using Mann Whitney U test, a non parametric alternative of independent t test. All statistical analyses were done using SPSS 11.0 (Chicago, USA) software.

RESULTS:

The median (range) absolute values of urinary11- dehydrothromboxane B2 levels for the healthy volunteers and cases were 440 (286-2050) pg/ml and 320 (72-2600) pg/ml (P=0.007). The corresponding normalized values were 87.3 (43-143) and 60.8 (16.7-943) ng/mmol of creatinine (P=0.131). Among the various vascular risk factors, patients who were overweight had higher absolute levels of 11- urinary dehydrothomboxane B2 levels (P=0.016). There were significantly more clinical events in patients with absolute urinary 11-dehydrothromboxane B2 levels in the upper two quartiles compared to the lower two quartiles (P=0.04).

CONCLUSION:

The incidence of aspirin resistance in the cohort of patients with documented heart disease was 38.1%. Patients with elevated absolute urinary dehydrothomboxane levels (>320 pg/ml) on chronic aspirin therapy constitute a high risk subset for recurrent vascular events.

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