Kardiyovasküler hastalarda antitrombositik tedaviye yanıtın optik agregometre ve pfa–100 ile incelenmesi
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Date
2010-02-15
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Uludağ Üniversitesi
Abstract
Kardiyovasküler hastalarda antitrombositik ilaçların vasküler olayları azalttığı, bazı hastalarda ise antitrombositik tedaviye rağmen vasküler olay yaşayan hastaların olduğu bilinmektedir. Çalışmamızda, aspirin ve klopidogrelin trombositler üzerindeki etkileri değerlendirilmiş ve antitrombositik ilaç direncinin sıklığı araştırılmıştır. Antitrombositik tedavi gören 72 kardiyovasküler hasta ve 22 gönüllü değerlendirildi. Agregometrede ADP, kollajen ve epinefrine karşı % maksimum agregasyon cevapları ve maksimum agregasyona ulaşma süreleri ve PFA– 100 ile Kollajen/Epinefrin ve Kollajen/ADP kartuşlarında kapanma zamanları saptandı. Antitrombositik tedaviye rağmen trombosit fonksiyonları kontrol grubu sınırları içinde olan hastalar aspirine veya klopidogrele dirençli kabul edildi. Agregometre ile ölçülen maksimum agregasyon yanıtlarında aspirinin özellikle epinefrin ve kollajene karşı, klopidogrel’in ise esas olarak ADP’ye karşı olan agregasyonu azalttığı gözlendi. Kombine ilaç grubunda en düşük maksimum agregasyon yanıtları alındı. PFA–100’de aspirin kullanımı yalnızca Kollajen/Epinefrin kartuşu kapanma zamanını uzattı. Aspirin direnci 12/37, klopidogrel direnci 1/17 sıklığında bulundu. PFA–100 ve agregometre arasında ilaç direncinin saptanmasına dair bir ilişki bulunamadı. Antitrombositik ilaçların trombositler üzerinde farklı etkilere sahip oldukları ve trombosit fonksiyonlarının değerlendirilmesinde kullanılan yöntemlerin birbirleriyle ilişkili olmadığı gözlendi.
Many studies have shown that antiplatelet drugs decrease vascular events while some patients experience vascular events despite the antiplatelet treatment. We evaluated the effects of aspirin and clopidogrel on platelet functions and investigated the incidence of antiplatelet drug resistance. The study group consisted of 72 cardiovascular patients using antiplatelet drugs and 22 volunteers. The % maximum aggregation and time to reach maximum aggregation against ADP, collagen and epinephrine were determined. Collagen/Epinephrine and Collagen/ADP cartridges closure times were recorded. Those with platelet functions within the control group limits despite antiplatelet treatment were considered to be resistant to drugs. Aspirin decreased the aggregation response especially against epinephrine and collagen while clopidogrel mainly decreased the aggregation response against ADP. The combined drug group had the lowest maximum aggregation responses. PFA100 showed that aspirin increased only Collagen/Epinephrine cartridge’s closure times. The incidence of aspirin resistance was 12/37 and clopidogrel resistance was 1/17. We found no association between the PFA-100 and the aggregometer in determining drug resistance. We observed that antiplatelet drugs had various effects on platelets and that the methods used to assess platelet functions did not show correlation with each other
Many studies have shown that antiplatelet drugs decrease vascular events while some patients experience vascular events despite the antiplatelet treatment. We evaluated the effects of aspirin and clopidogrel on platelet functions and investigated the incidence of antiplatelet drug resistance. The study group consisted of 72 cardiovascular patients using antiplatelet drugs and 22 volunteers. The % maximum aggregation and time to reach maximum aggregation against ADP, collagen and epinephrine were determined. Collagen/Epinephrine and Collagen/ADP cartridges closure times were recorded. Those with platelet functions within the control group limits despite antiplatelet treatment were considered to be resistant to drugs. Aspirin decreased the aggregation response especially against epinephrine and collagen while clopidogrel mainly decreased the aggregation response against ADP. The combined drug group had the lowest maximum aggregation responses. PFA100 showed that aspirin increased only Collagen/Epinephrine cartridge’s closure times. The incidence of aspirin resistance was 12/37 and clopidogrel resistance was 1/17. We found no association between the PFA-100 and the aggregometer in determining drug resistance. We observed that antiplatelet drugs had various effects on platelets and that the methods used to assess platelet functions did not show correlation with each other
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Keywords
Trombosit, Platelet, Aspirin, Clopidogrel, Aggregometer, PFA-100, Aspirin, Klopidogrel, Agregometre
Citation
Sağdilek, E. vd. (2010). "Kardiyovasküler hastalarda antitrombositik tedaviye yanıtın optik agregometre ve pfa–100 ile incelenmesi" Uludağ Üniversitesi Tıp Fakültesi Dergisi, 36(1),11-17.