Aspirin "resistance" and risk of cardiovascular morbidity: systematic review and meta-analysis
Aspirin "resistance" and risk of cardiovascular morbidity: systematic review and meta-analysis
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DOI：
10.1136/bmj.39430.529549.be
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发表时间：
2008-01-26
影响因子：
105.7
通讯作者：
Buchanan, Michael R.
中科院分区：
文献类型：
--
作者：
Krasopoulos, George;Brister, Stephanie J.;Buchanan, Michael R.
目的探讨阿司匹林抵抗与心血管疾病患者临床结局之间的关系，设计系统综述和荟萃分析，数据来源电子文献检索，不受语言限制，检索4个数据库，手工检索相关文献，纳入标准包括血小板反应性和临床结局的检测。阿司匹林抵抗进行了评估，使用各种血小板功能assays.Results 20项研究，共2930例心血管疾病患者被确定。大多数研究使用阿司匹林方案，范围为每日75-325 mg，6项研究包括辅助抗血小板治疗。在14项研究中直接确认了依从性，在3项研究中通过电话或访谈确认了依从性。3项研究的信息不足以评估依从性。总体而言，810例患者（28%）被归类为阿司匹林抵抗。41%的患者发生心血管相关事件（比值比3.85，95%置信区间3.08 - 4.80），5.7%的患者死亡（5.99，2.28 - 15.72），39.4%的患者发生急性冠脉综合征（4.06，2.96 - 5.56）。阿司匹林抵抗的患者没有受益于其他抗血小板治疗。结论阿司匹林抵抗的患者是在临床上重要的心血管疾病的发病率长期比阿司匹林敏感的患者更大的风险。
Objective To determine if there is a relation between aspirin "resistance" and clinical outcomes in patients with cardiovascular disease.Design Systematic review and meta-anatysis.Data source Electronic literature search without language restrictions of four databases and hand search of bibliographies for other relevant articles.Review methods Inclusion criteria included a test for platelet responsiveness and clinical outcomes. Aspirin resistance was assessed, using a variety of platelet function assays.Results 20 studies totalling 2930 patients with cardiovascular disease were identified. Most studies used aspirin regimens, ranging from 75-325 mg daily, and six studies included adjunct antiplatelet therapy. Compliance was confirmed directly in 14 studies and by telephone or interviews in three. Information was insufficient to assess compliance in three studies. Overall, 810 patients (28%) were classified as aspirin resistant. A cardiovascular related event occurred in 41% of patients (odds ratio 3.85, 95% confidence interval 3.08 to 4.80), death in 5.7% (5.99, 2.28 to 15.72), and an acute coronary syndrome in 39.4% (4.06, 2.96 to 5.56). Aspirin resistant patients did not benefit from other antiplatelet treatment.Conclusion Patients who are resistant to aspirin are at a greater risk of clinically important cardiovascular morbidity long term than patients who are sensitive to aspirin.