Randomized controlled trial comparing impact on platelet reactivity of twice-daily with once-daily aspirin in people with Type 2 diabetes
Randomized controlled trial comparing impact on platelet reactivity of twice-daily with once-daily aspirin in people with Type 2 diabetes
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DOI：
10.1111/dme.12828
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发表时间：
2016-02-01
影响因子：
3.5
通讯作者：
Holman, R. R.
中科院分区：
文献类型：
--
作者：
Bethel, M. A.;Harrison, P.;Holman, R. R.
AIMS降低了阿司匹林的疗效，已经在2型糖尿病患者中得到证实。由于增加的血小板反应性和/或更新率是可能的机制，我们检验了更高和/或更频繁的阿司匹林剂量是否可以更有效地降低血小板反应性。方法将24名没有已知心血管疾病的2型糖尿病患者随机分为三组，每天服用阿司匹林100 mg，每天服用200 mg，每天服用100 mg，每天2次，疗程2周。主要结果是使用VerifyNow(TM)ASA方法评估血小板的反应性。用随机受试者效应的广义线性混合模型检验了血小板反应性与阿司匹林剂量之间的关系。结果所有剂量的阿司匹林均可降低血小板反应性。每天两次服用100毫克阿司匹林比每天服用100毫克阿司匹林更有效地降低了模拟的血小板反应性，但每天服用200毫克阿司匹林并不能更有效地降低模型中的血小板反应性。每天服用200毫克阿司匹林与每天服用100毫克阿司匹林没有什么不同。每天两次服用100毫克阿司匹林也比每天一次更有效，通过胶原/肾上腺素刺激的血小板聚集和尿血栓素水平来衡量，通过血清血栓素水平来衡量类似的趋势。无出血发生。结论在2型糖尿病患者中，每日两次服用阿司匹林100毫克比每日服用100毫克更有效地降低血小板反应性，每天服用阿司匹林超过200毫克。评估2型糖尿病患者使用阿司匹林预防心血管疾病的临床结果试验可能需要考虑使用更频繁的给药方案。
Aims Reduced aspirin efficacy has been demonstrated in people with Type 2 diabetes. Because increased platelet reactivity and/or turnover are postulated mechanisms, we examined whether higher and/or more frequent aspirin dosing might reduce platelet reactivity more effectively.Methods Participants with Type 2 diabetes (n = 24) but without known cardiovascular disease were randomized in a three-way crossover design to 2-week treatment periods with aspirin 100 mg once daily, 200 mg once daily or 100 mg twice daily. The primary outcome was platelet reactivity, assessed using the VerifyNow (TM) ASA method. Relationships between platelet reactivity and aspirin dosing were examined using generalized linear mixed models with random subject effects.Results Platelet reactivity decreased from baseline with all doses of aspirin. Modelled platelet reactivity was more effectively reduced with aspirin 100 mg twice daily vs. 100 mg once daily, but not vs. 200 mg once daily. Aspirin 200 mg once daily did not differ from 100 mg once daily. Aspirin 100 mg twice daily was also more effective than once daily as measured by collagen/epinephrine-stimulated platelet aggregation and urinary thromboxane levels, with a similar trend measured by serum thromboxane levels. No episodes of bleeding occurred.Conclusions In Type 2 diabetes, aspirin 100 mg twice daily reduced platelet reactivity more effectively than 100 mg once daily, and numerically more than 200 mg once daily. Clinical outcome trials evaluating primary cardiovascular disease prevention with aspirin in Type 2 diabetes may need to consider using a more frequent dosing schedule.