Evaluation of Aspirin and Clopidogrel resistance in patients with Acute Coronary Syndrome by using Adenosine Diposphate Test and Aspirin Test

Abstract

Objectives: To evaluate Aspirin and Clopidogrel resistance/non-responders in patients with acute coronary syndrome (ACS) by using adenosine diposphate and aspirin tests. Methodology: In the study patients with ACS loaded with 300 mg of clopidogrel and 300 mg aspirin and patients on stable daily dose of 75 mg of clopidogrel (more than 3 days) underwent PCI. Response to clopidogrel and Aspirin was assessed by Adenosine Diphosphate (ADP) Test (20 µmol/L) and Aspirin Test (Acetyl Acid) (ASP) 20 µmol/L, respectively, using the Multiplate Platelet Function Analyzer (Dynabyte Medical, Munich, Germany). Results: Sixty four patients were included in this study out of which 57 were with ACS and 7 scheduled for percutaneous coronary intervention (PCI) electively. The proportion of Aspirin good responders and adequate responders were 76.56% and 18.75%, respectively while adequate response and good response to Clopidogrel accounted for 29.7 and 48.4%, respectively Hyperlipidaemia was only co-morbidity associated with higher AUC ADP value (p: 0.046). Hypertriglyceridaemia and serum calcium were weakly correlated with higher AUC ADP serum calcium r=0.08, triglyceride r=0.12. Patients admitted for scheduled PCI and on stable dose of 75mg clopidogrel exhibited lower AUC ADP value as compared to those admitted with acute coronary syndrome given loading dose of 300mg of Clopidogrel. Post loading dose measurement of anti-platelet therapy among ACS patients using the Multiplate Platelet Function Analyzer showed comparable results with other methods. Conclusions : As determined by Multiplate Platelet Function Analyzer, Aspirin resistance/non-responders in this study in acute coronary syndrome patients accounted for 4.69% while Non-responders in Clopidogrel was 21.9%.

Only Hyperuricemia with Crystalluria, but not Asymptomatic Hyperuricemia, Drives Progression of Chronic Kidney Disease

“…28,78,[82][83][84] M1-like macrophages were present in mice with chronic UA crystal nephropathy and suppressing the M1-like phenotype with adenosine significantly attenuated granulomatous interstitial nephritis and the progression to CKD. This finding is consistent with previous in vitro and in vivo reports that demonstrated beneficial effects of targeting adenosine receptor signaling in macrophages in various animal models of CKD [64][65][66][85][86][87][88][89] including other chronic crystalline nephropathies. 47,90 An effect of adenosine on other immune cell subsets inside and outside of the kidney may also contribute to the functional and structural outcomes.…”

The Impact of CYP2C19 Loss-of-Function Polymorphisms, Clinical, and Demographic Variables on Platelet Response to Clopidogrel Evaluated Using Impedance Aggregometry

“…Similar results have been reported previously. 33,34 Regarding statin concomitant administration, we found no difference between those on or without such treatment in terms of clopidogrel resistance. This is in line with most published data, [35][36][37] but detrimental effects of statin treatment (especially those metabolized by CYP3A4) have been suggested.…”

Aspirin resistance in patients with acute coronary events: Risk factors and prevalence as determined by whole blood multiple electrode aggregometry

“…Method of performing the test using Multiplate® platelet analyzer: The test was performed as per method described by Ibrahim et al 11 Briefly after positioning and connecting the test cells; 300µl of the saline and 300µl of whole blood sample (hirudinised) was pipetted into each cell. Results took six minutes to be ready and the aggregation results were shown in AU units, velocity and area under the curve (AUC).…”

“…We have previously evaluated clopidogrel and aspirin resistance in different groups of patients with coronary events. 11 However, studies comparing aspirin resistance in patients with the first-ever coronary and recurrent coronary events are scanty.…”